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Ultrasound guidance for placement of central venous catheters: A meta-analysis of the literature

Randolph, Adrienne G. MD; Cook, Deborah J. MD, FRCPC, MSc(Epid); Gonzales, Calle A. MD, MPH; Pribble, Charles G. MD

Special Article

Objective To evaluate the effect of real-time ultrasound guidance using a regular or Doppler ultrasound technique for placement of central venous catheters.

Data Sources We searched for published and unpublished research using MEDLINE, citation review of relevant primary and review articles, conference abstracts, personal files, and contact with expert informants.

Study Selection From a pool of 208 randomized, controlled trials of venous and arterial catheter management, eight published randomized, controlled trials were identified.

Data Extraction In duplicate, independently, we abstracted data on the population, intervention, outcome, and methodologic quality.

Data Synthesis Ultrasound guidance significantly decreases internal jugular and subclavian catheter placement failure (relative risk 0.32; 95% confidence interval 0.18 to 0.55), decreases complications during catheter placement (relative risk 0.22; 95% confidence interval 0.10 to 0.45), and decreases the need for multiple catheter placement attempts (relative risk 0.60; 95% confidence interval 0.45 to 0.79) when compared with the standard landmark placement technique.

Conclusions When used for vessel location and catheter placement real-time, ultrasound guidance or Doppler ultrasound guidance improves success rates and decreases the complications associated with internal jugular and subclavian venous catheter placement. (Crit Care Med 1996; 24:2053-2058)

From the Division of Pediatric Critical Care, Primary Children's Medical Center and Pulmonary Division, LDS Hospital (Dr. Randolph), University of Utah, Salt Lake City, UT; the Department of Clinical Epidemiology and Biostatistics and the Department of Medicine (Division of Critical Care) (Dr. Cook), McMaster University, Hamilton, ON, Canada; the Division of Pediatric Critical Care (Dr. Gonzales), University of California, San Francisco, CA; and the Division of Pediatric Critical Care and Pediatric Anesthesia (Dr. Pribble), Primary Children's Medical Center, University of Utah, Salt Lake City, UT.

Supported, in part, by National Research Service Award F32 HS00 106-01 from the Agency for Health Care Policy and Research (Dr. Randolph).

© Williams & Wilkins 1996. All Rights Reserved.