CONCLUSION
Notwithstanding inconsistencies in CVC placement guidelines,7,9,10 TCS-guided PICC insertions seem to produce lower rates of tip malposition and PICC-related complications; however, PICCs inserted with the Sherlock 3CG TCS tend to be located further into the RA or right ventricle (RV) than conventionally placed PICCs under fluoroscopic or radiographic guidance, and might induce arrhythmias upon changes in patient’s position. In unconscious and sedated patients as well as in patients under general anesthesia, these arrhythmias should be suspected, and vigilant ECG monitoring should be performed. Positioning the patient in the final intraoperative position immediately after PICC insertion might be reasonable; however, further studies are required to assess the validity of its routine implementation.