Table 2.

Summary of studies included [9–14]

References	Study design and details	Population	Intervention and previous technology	Accuracy of Sherlock 3CG® TCS (ECG tip placement in agreement with subsequent X-raya)	Comments by the EAC
Johnston (peer reviewed paper) [13]	Consecutive case series (UK)	ICU patients needing PICC insertion, excluding those not in sinus rhythm (n = 250) 11/250 (4.4 %) excluded	Sherlock 3CG® TCS. Previously used chest X-ray confirmation	79.5 % of PICCs in acceptable position (mid and lower SVC/CAJ/high RA	Peer-reviewed publication. Aims, methods, patient population, results and exclusion criteria are fully reported. Chest X-rays reviewed by at least 2 authors
Barton [12]	Case series (UK), abstract and additional information from author	Adults with no AF needing PICC insertion (n = 65 in original study, n = 225 total, including follow up) 11/225 (4.9 %) excluded	Sherlock 3CG® TCS. Previously used chest X-ray confirmation	100 % of PICCs in acceptable position (lower 1/3 of SVC or CAJ)	Full critical appraisal not possible, not peer reviewed
Adams [9]	Case series (USA), abstract and poster	People needing PICC insertion excluding those without identifiable p-wave (n = 333) 55/333 (16.5 %) excluded	Sherlock 3CG® TCS. Previously used chest X-ray confirmation	96.4 % on 1st review 98.2 % on 2nd review	Full critical appraisal not possible, not peer reviewed
Stewart [11]	Case series (Australia), abstract and poster	Unknown, abstract states “over 65” patients treated	Sherlock 3CG® TCS. Previously used chest X-ray confirmation	96 % within CAJ 4 % within RA Number unable to confirm tip location using Sherlock 3CG® TCS not reported	Minimal information available, full critical appraisal not possible, not peer reviewed. Information should be treated cautiously
Parikh [10]	Prospective case series (USA), abstract and poster. Two phases, with increased nurse training in 2nd phase. Additional patients after trial also reported	People needing PICC insertion excluding those with AF, atrial flutter, increased risk of bleeding and without identifiable p-wave 1st phase n = 65, 3/65 (4.6 %) excluded, 2nd phase, n = 182 35/182 (19.2 %) excluded	Sherlock 3CG® TCS. Previously used Sherlock II TLS (magnetic tracking) plus chest X-ray confirmation	Phase 1:83 % placed within SVC or CAJ Phase 2: 96 % placed within SVC or CAJ	Poster, not peer reviewed, but with sufficient detail for partial critical appraisal. Clear patient population, tip position criteria, exclusion criteria, assessment by 2 independent operators For follow up phase patients, 437/567 (77 %) used Sherlock 3CG® TCS, 109/437 (25 %) still required a chest X-ray
Symington [14]	Prospective case series (USA). Presentation	People needing a PICC insertion (n = 63)	Sherlock 3CG® TCS. Previously used Sherlock II TLS (magnetic tracking) plus chest x = ray confirmation	98.4 % placed in acceptable position	Minimal information available, full critical appraisal not possible, not peer reviewed

CAJ cavo-atrial junction, PICC peripherally inserted central catheter, RA right atrium, SVC superior vena cava

^aAccuracy outcomes only include patients where a successful ECG tip placement was thought to have been achieved. If ECG tip confirmation was not achieved, then these patients would be in the excluded category