Ultrasonic locating devices for central venous cannulation: meta-analysis

By D. Hind, N. Calvert, R. McWilliams, A. Davidson, S. Paisley, Catherine Beverley, Steven Thomas. British medical journal, 2003

1,106 citations recorded by the source corpus.

Abstract Objectives To assess the evidence for the clinical effectiveness of ultrasound guided central venous cannulation. Data sources 15 electronic bibliographic databases, covering biomedical, science, social science, health economics, and grey literature. Design Systematic review and meta-analysis of randomised controlled trials. Populations Patients scheduled for central venous access. Intervention reviewed Guidance using real time two dimensional ultrasonography or Doppler needles and probes compared with the anatomical landmark method of cannulation. Data extraction Risk of failed catheter placement (primary outcome), risk of complications from placement, risk of failure on first attempt at placement, number of attempts to successful catheterisation, and time (seconds) to successful catheterisation. Data synthesis 18 trials (1646 participants) were identified. Compared with the landmark method, real time two dimensional ultrasound guidance for cannulating the internal jugular vein in adults was associated with a significantly lower failure rate both overall (relative risk 0.14, 95% confidence interval 0.06 to 0.33) and on the first attempt (0.59, 0.39 to 0.88). Limited evidence favoured two dimensional ultrasound guidance for subclavian vein and femoral vein procedures in adults (0.14, 0.04 to 0.57 and 0.29, 0.07 to 1.21, respectively). Three studies in infants confirmed a higher success rate with two dimensional ultrasonography for internal jugular procedures (0.15, 0.03 to 0.64). Doppler guided cannulation of the internal jugular vein in adults was more successful than the landmark method (0.39, 0.17 to 0.92), but the landmark method was more successful for subclavian vein procedures (1.48, 1.03 to 2.14). No significant difference was found between these techniques for cannulation of the internal jugular vein in infants. An indirect comparison of relative risks suggested that two dimensional ultrasonography would be more successful than Doppler guidance for subclavian vein procedures in adults (0.09, 0.02 to 0.38). Conclusions Evidence supports the use of two dimensional ultrasonography for central venous cannulation.

Subfields: Emergency Medical Services, Surgery

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Citations in the corpus

• International evidence-based recommendations on ultrasound-guided vascular access (2012, background): “Although most of the randomised clinical trials carried out in this area have focused on the internal jugular vein [9–12, 34, 36, 59, 60] and—to a lesser extent—on the subclavian vein [9, 41] and the femoral vein [6], it is likely that with growing clinical experience the benefits of ultrasound-guid”
• epic3: National Evidence-Based Guidelines for Preventing Healthcare-Associated Infections in NHS Hospitals in England (2007, methodology): “438 Two meta-analyses 439, 440 indicate that the use of real-time two-dimensional ultrasound for the placement of CVCs substantially reduced mechanical complications compared with the standard landmark placement technique.”
• Guidelines for the prevention of intravascular catheter-related infections. (2002, positive): “Evidence favors the use of two-dimensional ultrasound guidance over Doppler ultrasound guidance [60].”
• Guidelines for the prevention of intravascular catheter-related infections. (2002, neutral): “pared with the standard landmark placement [60, 61].”
• Guidelines for the prevention of intravascular catheter-related infections. (2011, neutral): “Σε δύο μελέτες μετα-ανάλυσης, η χρήση συσκευής υπερήχου δύο διαστάσεων κατά την τοποθέτηση των ΚΦΚ μείωσε σημαντικά τις μηχανικές επιπλοκές και τον αριθμό των ανεπιτυχών προσπαθειών καθετηριασμού [60, 61].”