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

Abstract

Central venous access devices are often needed in neonates admitted to Neonatal Intensive Care Unit. The location of the tip of the central catheter is usually assessed by post-procedural X-ray. However, this strategy is inaccurate and time consuming. Recent guidelines strongly recommend intra-procedural methods of tip location, to increase the cost-effectiveness of the maneuver and to shorten the time between device placement and utilization. In this regard, real-time ultrasound represents the most promising tool for tip navigation and location in neonates. The aim of this paper is (a) to review all the evidence available about ultrasound-based tip navigation and tip location of central catheters in the neonatal population (b) to propose a novel protocol for tip navigation and location (Neo-ECHOTIP) based on such evidence.

Umbilical Venous Catheter Update: A Narrative Review Including Ultrasound and Training

“…Several authors have studied the most effective method for adequate training of pediatric residents in the placement of UVCs (39,40) The newest and most interesting development in UVC insertion is indeed the introduction of ultrasound-based methods for tip navigation and tip location. The use of point-of-care ultrasound (POCUS) to visualize umbilical catheters during the procedure is rapidly spreading among neonatologists (11,12,(42)(43)(44) (Figure 2).…”

“…Realtime ultrasound for tip navigation and tip location of UVC is accurate, safe, and cost-effective. It is reasonable to predict that real-time ultrasound will shortly become a new standard of care with the support of standardized protocols defining the proper technique ( 42 ).…”

“…Radiological methods of tip location should be discouraged. As compared to intraprocedural ultrasound ( 42 ), post-procedural radiological assessment of UVC position implies an inevitable delay in starting the infusions, is more invasive, more difficult from the logistic point of view, less accurate and less cost-effective, and—last but not least—it is less safe. In fact, in a retrospective analysis of 215 premature infants, Scott et al ( 55 ) found that 12.1% of the infants with a GA <33 weeks received more than the maximum recommended ionizing radiation exposure (1,000 mSv) during their NICU stay and that central lines placement accounted for 19.2% of the total radiation exposure.…”

Use of Wireless Ultrasound Probe in Isolated Infants: A Case Report of Two SARS-CoV-2-Positive Mothers’ Newborns

“…The probe used has a double interface Horus (ATL® Milan, Italy): a linear probe for lung ultrasound, using a frequency of 10–12 MHz, and a microconvex probe for catheter tip visualization, using a frequency of 5–7 MHz. We performed lung ultrasound observing ESPNIC guidelines [ 2 ]; the UVC tip visualization was carried out following the indications of Neo-ECHOTIP [ 17 ]. In the first case, the use of ultrasound with a wireless probe was very useful because it allowed the operators to carry out diagnosis and therapy within the first hour of life of the critically ill newborn.…”

The SIF protocol: A seven-step strategy to minimize complications potentially related to the insertion of femorally inserted central catheters

“…2 When intracavitary ECG is not applicable or not feasible, another effective, inexpensive, and non-invasive intraprocedural method for tip location is transthoracic echocardiography (TTE): RA and IVC/RAJ are well visible by ultrasound in subcostal view, with convex or sectorial probe; the "bubble test" (a rapid infusion of a few milliliters of "agitated" saline solution) allows for better visualization of the catheter tip. [40][41][42]…”