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

Abstract

Central venous access devices are routinely used in pediatric care for administration of fluids and medications and for drawing blood samples. The adoption of ultrasound guided venipuncture, the availability of bedside ultrasound devices and the use of intraprocedural methods for tip location have been shown to reduce procedure-related complications, as documented by the recommendations of most recent guidelines. In pediatric patients, bedside ultrasound is a promising tool not only for optimizing the choice of the vein and guiding the venipuncture, but also for ensuring an accurate and intraprocedural method of tip navigation and tip location. The aim of this paper is to review all the evidence about the accuracy of ultrasound methods for tip navigation and tip location in pediatric patients, and to suggest a structured protocol for clinical practice.

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

“…In pediatric patients, ultrasound is considered the second and most reliable method for verification of the tip location. 6,18,19,38 A micro-convex probe (4–8 MHz) or small sectorial probe (3–7 MHz) was used for the tip location, in most cases with a subcostal bi-caval projection. The maneuver was particularly feasible in neonates and in infants, as reported in our data.…”

“…6 (4) Intra-procedural verification of the central position of the tip by non-invasive methods: Intracavitary ECG technique was used to control the correct position of the catheter tip, 20,21 in most cases. Ultrasound was often used as an additional method to confirm tip location, 18,19 in association with intracavitary ECG. In some cases of FICC insertion, if the tip had been planned to be in the inferior vena cava, the correct position of the tip was verified by ultrasound-based tip location only.…”

“…(3) Ultrasound-guidance : Real-time ultrasound guided venipuncture of the chosen vein was consistently adopted, with different techniques in terms of vein view (short axis, long axis, oblique axis) and needle approach (in-plane, out-of-plane), depending on the vein considered and on the clinical situation. 6 Ultrasound was also used to assess the proper direction of the guidewire and of the catheter (ultrasound-based tip navigation), according to the ECHOTIP-Ped 18 and to the Neo-ECHOTIP protocols. 19 In case of CICC insertion, ultrasound was also used to assess the absence of pneumothorax, immediately after venipuncture, as currently recommended.…”

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

“…Our protocol (nicknamed “ECHOTIP”) will focus on practical issues such as the choice of the probe and of the acoustic window as well as the definition of the best method for ultrasound visualization of the guidewire and/or catheter and/or tip. The same issue has been already addressed in two recent studies carried out by our group in the context of pediatric 13 and neonatal 14 populations.…”

Therapeutic Effect of Ultrasound-Guided Peripherally Inserted Central Catheter Combined with Predictive Nursing in Patients with Large-Area Severe Burns

“…However, all the existing related researches in the world directly reported the application of predictive nursing in the PICC of burn patients under the ultrasound-guided modified Seldinger technique. As for the application effect of the modified Seldinger technique in the PICC of burn patients under the guidance of ultrasound, further research is needed [ 15 ].…”