An Italian expert consensus on the choice of the method of tip location for central venous access devices

Tip location of central venous access devices is considered highly relevant for the purpose of reducing catheter-related complications and prolong the duration of the access. Though, the choice of the method of tip location currently relies upon the operator's experience, preference, and training, on the local availability of specific resources and technologies, and on local policies. On the contrary, considering the relevance of tip location, such clinical choice should preferably be based on the best available evidence. Though current guidelines recommend intra-procedural rather than post-procedural methods of tip location, many clinicians still adopt the strategy of assessing the position of the tip by radiological methods after the completion of the procedure. Also, though current guidelines and evidence-based documents recommend the intra-cavitary electrocardiography and/or trans-thoracic echocardiography as preferred methods of intraprocedural tip location, many clinicians still adopt fluoroscopy. While the pros and cons of each different method of tip location are well known, there is no evidence-based document that offer robust recommendations about the choice of tip location of different central venous access devices in different population of patients (neonates, children, adults). Therefore, the Italian Group of Long-Term Venous Access Devices (GAVeCeLT) and the Italian Vascular Access Society (IVAS) have developed a national consensus on the choice of the most appropriate method of tip location. After a systematic review of the available evidence, the panel of the consensus (which included 22 Italian experts with documented competence in this area) has provided structured recommendations answering six key questions regarding the choice between intra-procedural and post-procedural tip location, as well as the appropriate indication of the four different methods of intra-procedural tip location currently available (trans-esophageal echocardiography, trans-thoracic echocardiography, intracavitary electrocardiography, and fluoroscopy). Only statements reaching a 100% agreement were included in the final recommendations.