Key result
Real-time ultrasound is the only acceptable methodology for tip navigation in neonates, while intracavitary ECG and ultrasound have specific preferred indications for tip location based on catheter type.
Why the study?
Intracavitary electrocardiography and real-time ultrasound offer different advantages and disadvantages for central venous access device tip navigation and location in neonates.
What are the preferred methods for tip navigation and location of central venous access devices in neonates?
What are the preferred methods for tip navigation and location of central venous access devices in neonates?
Real-time ultrasound and intracavitary ECG offer distinct advantages for central venous access device tip location in neonates depending on the insertion site, with ultrasound being universally preferred for tip navigation.
Guidelines endorse real-time tip confirmation in neonates; extends applicability but leaves optimal technique unresolved.
The proper location of the tip of a central venous access device plays a crucial role in minimizing the risks potentially associated with its use. Recent guidelines strongly recommend preferring real-time, intra-procedural methods of tip location since they are more accurate, more reliable and more cost-effective than post-procedural methods. Intracavitary electrocardiography and real time ultrasound can both be applied in the neonatal setting, but they offer different advantages or disadvantages depending on the type of central venous access device. Reviewing the evidence currently available about the use of these two methods in neonates, in terms of applicability, feasibility and accuracy, it can be concluded that (a) real time ultrasound is the only acceptable methodology for tip navigation for any central venous access device in neonates, (b) intracavitary electrocardiography is the preferred method of tip location for central catheters inserted by ultrasound-guided cannulation of the internal jugular vein or the brachiocephalic vein, and (c) real time ultrasound is the preferred method of tip location for umbilical venous catheters, epicutaneo-cava catheters, and central catheters inserted by ultrasound-guided cannulation of the common femoral vein.
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Natile et al. (2024) conducted a review in Neonates requiring central venous access devices. Intracavitary ECG and real-time ultrasound was evaluated on Applicability, feasibility, and accuracy of tip navigation and location methods. Real-time ultrasound is the only acceptable methodology for tip navigation in neonates, while intracavitary ECG and ultrasound have specific preferred indications for tip location based on catheter type.
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