Ultrasound-based tip navigation and tip location during placement of central venous access devices in adult patients: The ECHOTIP protocol revisited

Abstract

Ultrasound has an important role in many aspects of central venous catheterization. In the last decade, bedside ultrasound has been regarded as a promising tool also for ensuring an accurate and intraprocedural assessment of the location of the catheter tip, as an alternative or complimentary option to intracavitary electrocardiography. In this regard, 5 years ago the Italian Group of Venous Access Devices (GAVeCeLT) developed detailed protocols for the standardization of this methodology in different populations of patients: neonates (Neo-ECHOTIP), children (ECHOTIP-Ped), and adults (ECHOTIP). In the lapse of time since the publication of these protocols, recent clinical studies have brought novel information and new evidence, so that some recommendations included in the original ECHOTIP protocol for adults today may seem incomplete or inappropriate. For this reason, GAVeCeLT has developed an updated version of the protocol, nick-named ECHOTIP-2, which includes new recommendations in regards of some technical aspects of the procedure of bubble test and of the application of the method to femorally inserted central catheters.

Keywords: Central venous access devices; bubble test; intracavitary electrocardiography; pulse wave Doppler; tip location; transthoracic echocardiography.