ECHOTIP: A structured protocol for ultrasound-based tip navigation and tip location during placement of central venous access devices in adult patients

Greca, Antonio La; Iacobone, Emanuele; Elisei, Daniele; Biasucci, Daniele Guerino; D’Andrea, Vito; Barone, Giuseppe; Marinosci, Geremia Zito; Pittiruti, Mauro

doi:10.1177/11297298211044325

Cited by 41 publications

(40 citation statements)

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“…2 More recently, specific “insertion bundles” have been implemented to reduce any type of complication due to central venous catheterization in adults. 3–5 Most of these bundles include pivotal recommendations such as: (a) use of ultrasound for the choice of the vein, for real time ultrasound-guided venipuncture, for tip navigation, tip location, and for early detection of complications 6 ; (b) proper choice of the exit site 7,8 ; (c) skin antisepsis using 2% chlorhexidine in alcohol 9 ; (d) maximal barrier precautions 9 ; (e) intraprocedural tip location by intracavitary ECG 10 or ultrasound 11 ; (f) consistent use of sutureless devices 9 ; (g) use of cyanoacrylate glue for sealing the exit site. 12,13 All these new methodologies and technologies have contributed to reduce the incidence of complications, increasing the cost-effectiveness of CVAD insertion in adults.…”

Section: Introductionmentioning

confidence: 99%

A GAVeCeLT bundle for central venous catheterization in neonates and children: A prospective clinical study on 729 cases

2022

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Background: In the pediatric patient, central venous catheterization may be associated with relevant complications. Though, most of them may be prevented by a wise choice of materials, methods, and techniques. Evidence-based insertion bundles for central venous catheterization have been developed in the adult patient, but not in neonates and children. Methods: The Italian Group for Long Term Venous Access Devices (GAVeCeLT) has developed an insertion bundle for central venous catheterization in neonates, infants, and children, which includes seven evidence-based strategies: (1) preprocedural ultrasound evaluation, (2) appropriate aseptic technique, (3) ultrasound guided venipuncture, (4) intraprocedural tip location by non-radiological methods, (5) proper choice of the exit site by tunneling, (6) sutureless securement, and (7) protection of the exit site using glue and transparent membranes. The effectiveness and safety of this bundle has been tested in a prospective study. Results: All neonates, infants and children requiring a non-emergency central line (except for umbilical venous catheters and epicutaneo-cava catheters) were included in the study. Out of 729 central line insertions, there were no immediate complications (no pneumothorax, no arterial puncture, no malposition); the incidence of early and late complications (local ecchymosis, dislodgment, local pain, exit site infection) was 3.7%; in the first 2 weeks after insertion, no catheter-related bacterial infection or catheter-related thrombosis was recorded. Conclusion: The results of this prospective study strongly validate the hypothesis that an insertion bundle is highly effective in optimizing the safety of the maneuver, reducing immediate, early, and late complications.

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Section: Introductionmentioning

confidence: 99%

A GAVeCeLT bundle for central venous catheterization in neonates and children: A prospective clinical study on 729 cases

2022

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“…Previous studies demonstrated that ultrasound and intracavitary electrocardiography can be used for tip location and navigation. 12,13 The sensitivity and success rate were higher in the group using these devices than in that using anatomical landmarks to confirm the catheter tip location. 13 Although these methods completely avoid the need for fluoroscopy and/or chest radiography, these methods can be safe and useful options for assessing PICC at non-applicable status to fluoroscopy or emergency.…”

Section: Discussionmentioning

confidence: 92%

Peripherally Inserted Central Catheter by Interventional Nephrologists: Experiences from a Single Center

Kim¹,

Young²,

Cho³

et al. 2022

IJGM

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As the number of patients with chronic kidney disease increases, nephrologist activities are gradually expanding. This study evaluated the safety and success of peripherally inserted central catheter (PICC) performed by nephrologists. Patients and Methods: We retrospectively analyzed the medical records of a medical center. All patients underwent a PICC procedure by two nephrologists. The reasons for catheter removal were classified as accidental removal; treatment termination; catheter occlusion; vessel thrombosis; catheter-related infection, or patient death. Overall catheter complications were defined as catheter occlusion, vessel thrombosis, or catheter-related infection. Results: A total of 335 catheterizations among 286 patients were performed. Overall, catheter removal was required during follow-up in 251 of 335 cases. The catheter was removed in 48 out of 251 (19.1%) cases with catheter-related complications. In univariate and multivariate analyses, diabetes mellitus was associated with catheter-related infection. The catheter survival rates were 85.3% at 1 month. In univariate and multivariate analyses, diabetes mellitus and fluoroscopy-guided insertion were associated with favorable catheter survival. Conclusion:The results of our study showed high success and low complication rates for PICC insertion by nephrologists. These findings indicate that interventional nephrologists already skilled in other procedures can expand their field of activity and profit.

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“…37 Studies have also shown that the use of agitated saline with trans thoracic echocardiography (TTE) or transesophageal echocardiography (TEE) and more recently, the ECHOTIP protocol developed by La Greca and colleagues, to be effective in confirming catheter position in the SVC/RA. [38][39][40][41] However, these techniques require more advanced ultrasound skills and more than one operator to undertake appropriate ultrasound scanning, and may not be feasible for many institutions. A combination of both intra procedural scanning and IC ECG would be ideal if resources permitted.…”

Section: Discussionmentioning

confidence: 99%

A randomised trial of intracavitary electrocardiography versus surface landmark measurement for central venous access device placement

et al. 2022

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Background: Malpositioned central venous access devices (CVADs) can lead to significant patient injury including central vein thrombosis and dysrhythmias. Intra-cavitary electrocardiography (IC ECG) has been recommended by peak professional bodies as an accurate alternative for bedside CVAD insertion, to reduce risk of malposition and allowing immediate use of the device. Our objective was to compare the effect of IC ECG on CVAD malposition compared to traditional institutional practice for CVAD placement. Methods: Randomised controlled trial of IC ECG CVAD insertion verses traditional CVAD insertion (surface landmark measurement with post insertion x ray). Patient recruitment was from December 2016 to July 2018. The setting was a 900-bed tertiary referral hospital based in South Western Sydney, Australia. Three hundred and forty-four adult patients requiring CVAD insertion for intravenous therapy, were enrolled and randomly allocated (1:1 ratio) to either IC-ECG ( n = 172) or traditional ( n = 172) CVAD insertion. Our primary outcome of interest was the rate of catheters not requiring repositioning after insertion (ready for use). Secondary outcomes were comparison of procedure time and cost. Results: Of the 172 patients allocated to the IC ECG method, 170 (99%) were ready for use immediately compared to 139 of the 172 (81%) in the traditional insertion group (difference, 95% confidence interval (CI): 18%, 11.9–24.1%). The total procedure time was mean 15 min (SD 8 min) for IC ECG and mean 36 min (SD 17 min) for traditional CVAD insertion (difference–19.9 min (95% CI–14.6 to −34.4). IC ECG guided CVAD insertion had a cost reduction of AUD $62.00 per procedure. Conclusions: Using IC-ECG resulted in nearly no requirement for post-insertion repositioning of CVADs resulting in savings in time and cost and virtually eliminating the need for radiographic confirmation. Trial registration: This trial is registered at the Australian New Zealand Clinical Trials Registry ( http://www.anzctr.org.au ). The registration number is ACTRN12620000919910.

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ECHOTIP: A structured protocol for ultrasound-based tip navigation and tip location during placement of central venous access devices in adult patients

Cited by 41 publications

References 50 publications

A GAVeCeLT bundle for central venous catheterization in neonates and children: A prospective clinical study on 729 cases

A GAVeCeLT bundle for central venous catheterization in neonates and children: A prospective clinical study on 729 cases

Peripherally Inserted Central Catheter by Interventional Nephrologists: Experiences from a Single Center

A randomised trial of intracavitary electrocardiography versus surface landmark measurement for central venous access device placement

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