Faraone Vincenzo, Pittiruti Mauro, Annetta Maria Giuseppina, Barone Giovanni, Brescia Fabrizio, Calabrese Maria, Capasso Antonella, Capozzoli Giuseppe, D'Andrea Vito, D'Arrigo Sonia, Elisei Daniele, Elli Stefano, Giarretta Igor, Gidaro Antonio, Giustivi Davide, Iacobone Emanuele, Mastroianni Rossella, Pinelli Fulvio, Scoppettuolo Giancarlo, Spagnuolo Ferdinando, Zito Marinosci Geremia, Pepe Gilda, Biasucci Daniele G
Vascular Access Team, "Cardarelli" Hospital, Naples, Italy.
Department of Surgery, Catholic University Hospital "A. Gemelli," Rome, Italy.
J Vasc Access. 2025 May 1:11297298251336809. doi: 10.1177/11297298251336809.
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.
中心静脉通路装置的尖端位置对于减少导管相关并发症和延长通路使用时间而言被认为高度相关。然而，目前尖端位置确定方法的选择依赖于操作者的经验、偏好和培训，依赖于特定资源和技术的本地可得性，以及当地政策。相反，考虑到尖端位置的相关性，这种临床选择最好应基于现有的最佳证据。尽管当前指南推荐在操作过程中而非操作后进行尖端位置确定的方法，但许多临床医生仍采用在操作完成后通过放射学方法评估尖端位置的策略。此外，尽管当前指南和循证文件推荐腔内心电图和/或经胸超声心动图作为操作过程中尖端位置确定的首选方法，但许多临床医生仍采用荧光透视法。虽然每种不同尖端位置确定方法的利弊众所周知，但尚无循证文件针对不同患者群体（新生儿、儿童、成人）中不同中心静脉通路装置的尖端位置选择提供有力建议。因此，意大利长期静脉通路装置小组（GAVeCeLT）和意大利血管通路协会（IVAS）就最合适的尖端位置确定方法的选择达成了全国共识。在对现有证据进行系统回顾后，共识小组（其中包括22位在该领域有书面资质的意大利专家）提供了结构化建议，回答了关于操作过程中和操作后尖端位置确定之间的选择以及目前可用的四种操作过程中尖端位置确定不同方法（经食管超声心动图、经胸超声心动图、腔内心电图和荧光透视）的适当适应症的六个关键问题。最终建议仅纳入达成100%一致的陈述。
