Natile Miria, Ancora Gina, D'Andrea Vito, Pittiruti Mauro, Barone Giovanni
Neonatal Intensive Care Unit, Infermi Hospital, AUSL della Romagna, Rimini, Italy.
Neonatal Intensive Care Unit, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy.
J Vasc Access. 2024 Aug 1:11297298241259247. doi: 10.1177/11297298241259247.
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.
中心静脉通路装置尖端的正确位置对于将其使用可能带来的风险降至最低起着至关重要的作用。近期指南强烈建议优先采用实时、术中确定尖端位置的方法，因为它们比术后方法更准确、更可靠且更具成本效益。腔内心电图和实时超声均可应用于新生儿，但根据中心静脉通路装置的类型，它们具有不同的优缺点。从适用性、可行性和准确性方面审视目前有关这两种方法在新生儿中应用的证据，可以得出以下结论：(a) 实时超声是新生儿任何中心静脉通路装置尖端导航的唯一可接受方法；(b) 腔内心电图是通过超声引导颈内静脉或头臂静脉插管插入中心导管时确定尖端位置的首选方法；(c) 实时超声是脐静脉导管、经皮腔静脉导管以及通过超声引导股总静脉插管插入中心导管时确定尖端位置的首选方法。
