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Ultrasound-Guided Subclavian Vein Catheterization: A Systematic Review and Meta-Analysis

Lalu, Manoj M. MD, PhD, FRCPC1,2; Fayad, Ashraf MD, FRCPC1,2; Ahmed, Osman MD3; Bryson, Gregory L. MD, MSc, FRCPC1,2; Fergusson, Dean A. PhD2,4,5,6; Barron, Carly C. MSc3; Sullivan, Patrick MD, FRCPC1; Thompson, Calvin MD, FRCPC1

doi: 10.1097/CCM.0000000000000973
Review Articles

Objective: Although ultrasound guidance for subclavian vein catheterization has been well described, evidence for its use has not been comprehensively appraised. Thus, we conducted a systematic review and meta-analysis to determine whether ultrasound guidance of subclavian vein catheterization reduces catheterization failures and adverse events compared to the traditional “blind” landmark method. All forms of ultrasound were included (dynamic 2D ultrasound, static 2D ultrasound, and Doppler).

Data Sources: Medline, Embase, Cochrane Central Register of Controlled Trials, Cochrane Database of Systematic Reviews, and CINAHL (from inception to September 2014).

Study Selection: Randomized controlled trials of ultrasound compared to landmark technique for subclavian catheterization in adult populations were considered. Outcomes of interest included safety and failure of catheterization.

Data Extraction: Adverse event data were analyzed according to Peto’s method and expressed as odd ratios and 95% CIs. Failure of catheterization was analyzed with inverse variance random effects modeling and expressed as risk ratios and 95% CI.

Data Synthesis: Six hundred and one studies were reviewed and 10 met inclusion criteria (n = 2,168 participants). Six used dynamic 2D ultrasound (n = 719), one used static 2D ultrasound (n = 821), and three used Doppler-guided insertion techniques (n = 628). Overall complication rates were reduced with ultrasound use compared to the landmark group (odd ratio, 0.53; 95% CI, 0.41–0.69). Subgroup analysis demonstrated that dynamic 2D ultrasound reduced inadvertent arterial puncture, pneumothorax, and hematoma formation. No difference in failure of catheterization was noted between the ultrasound group and the landmark method (risk ratio, 0.85; 95% CI, 0.48–1.51). Subgroup analysis of dynamic 2D ultrasound demonstrated a significant decrease in failed catheterization (risk ratio, 0.24; 95% CI, 0.06–0.92).

Conclusions: Ultrasound-guided subclavian catheterization reduced the frequency of adverse events compared with the landmark technique. Our findings support the use of dynamic 2D ultrasound for subclavian catheterization to reduce adverse events and failed catheterization.

Supplemental Digital Content is available in the text.

1Department of Anesthesiology, The Ottawa Hospital, University of Ottawa, Ottawa, ON, Canada.

2The Ottawa Hospital Research Institute, Ottawa, ON, Canada.

3Faculty of Medicine, The University of Ottawa, Ottawa, ON, Canada.

4Department of Medicine, The University of Ottawa, Ottawa, ON, Canada.

5Department of Surgery, The University of Ottawa, Ottawa, ON, Canada.

6Department of Epidemiology and Community Medicine, The University of Ottawa, Ottawa, ON, Canada.

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Supported, in part, by institutional departmental funds.

Dr. Lalu was supported by a Heart and Stroke Foundation Research Fellowship. Dr. Ahmed and Ms. Barron were supported by the University of Ottawa Undergraduate Research Opportunity Program as well as the Chairman’s Fund from the Department of Anesthesiology, University of Ottawa, and The Ottawa Hospital. Dr. Bryson was supported by The Ottawa Hospital Anesthesia Alternate Funds Association. These sources of funding had no influence on the design and conduct of the study. The remaining authors have disclosed that they do not have any potential conflicts of interest.

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