BMJ  2003;327:361 (16 August), doi:10.1136/bmj.327.7411.361

Paper

Ultrasonic locating devices for central venous cannulation: meta-analysis

¹ School of Health and Related Research (ScHARR), Regent Court, Sheffield S1 4DA, ² Fourth Hurdle Consulting, London WC1R 4QA, ³ Royal Liverpool University Hospital, Liverpool L7 8XP, ⁴ Sheffield Teaching Hospitals NHS Trust, Royal Hallamshire Hospital, Sheffield S10 2JF, ⁵ Department of Academic Radiology, University of Sheffield, Northern General Hospital, Sheffield S5 7AU

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.

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Rapid Responses:

Read all Rapid Responses

Ultrasound for central venous cannulation.

Paul Jefferson, et al.
bmj.com, 18 Aug 2003 [Full text]

Statistically correct, not clinically relevant

Stuart M White
bmj.com, 2 Sep 2003 [Full text]