catheterisation. They conclude that the 2D ultrasound offers significant gains in safety and quality (based on higher success rate at first attempt) concerning internal jugular catheter insertion, but only small gains were obtained in subclavian and femoral vein assessment. There is although some concern about the poor quality of these studies and heterogeneity among them, especially regarding femoral vein venipuncture, making the recommendation for the use of US guidance in this case weaker.Additionally, US guidance is time-consuming and adds complexity to the procedure due to the equipment and training needs [4]. We support US guidance whenever possible for central venous catheter insertion, but we consider a higher threshold for its use, when this technique is less assessable, for subclavian and femoral venipuncture.Concerning catheter tip position assessment, we agree that tip positioning should stay between the right atrium and superior vena cava to diminish endothelium trauma, minimise complications and optimise catheter performance. The preferred and most used method for tip position assessment is intraoperative fluoroscopy; however, we absolutely agree that the intravascular electrocardiogram technique is a safe and simple alternative to this method [5]. Additionally, we also hold the comment on postoperative X-ray to be the least beneficial technique for tip position assessment, advisable mostly to diagnose postoperative complications.

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