Review articleThe effects of ultrasound guidance on first-attempt success for difficult peripheral intravenous catheterization: a systematic review and meta-analysisPoulsen, Evaa; Aagaard, Rasmusb,c; Bisgaard, Jannied,e; Sørensen, Heidi T.a; Juhl-Olsen, Petera,f Author Information aDepartment of Cardiothoracic- and Vascular Surgery, Anesthesia Section, Aarhus University Hospital bResearch Center for Emergency Medicine, Department of Clinical Medicine, Aarhus University, Aarhus cDepartment of Anesthesiology, Randers Regional Hospital, Randers dDepartment of Anesthesiology and Intensive Care, Aalborg University Hospital eDepartment of Clinical Medicine, Aalborg University, Aalborg fDepartment of Clinical Medicine, Aarhus University, Aarhus, Denmark Received 26 July 2022 Accepted 4 November 2022. Supplemental digital content is available for this article. Direct URL citations appear in the printed text and are provided in the HTML and PDF versions of this article on the journal's website (www.euro-emergencymed.com). Correspondence to Eva Poulsen, MD, Department of Cardiothoracic- and Vascular Surgery, Anesthesia Section, Aarhus University Hospital, Palle Juul-Jensens Boulevard 89, 8200 Aarhus N, Denmark Tel: +004522351059; E-mail: [email protected] European Journal of Emergency Medicine ():10.1097/MEJ.0000000000000993, January 20, 2023. | DOI: 10.1097/MEJ.0000000000000993 Buy SDC PAP Metrics Abstract Identifying patients at risk of difficult intravenous access (DIVA) and increasing the success rates of peripheral intravenous catheterization (PIVC), preferably on the first catheterization attempt, is of clinical importance. The aim of this study was to compare the use of dynamic ultrasound guidance for PIVC with the traditional technique of visualization and palpation in patients with predicted DIVA. A systematic review and meta-analysis comparing ultrasound-guided PIVC with the traditional technique was performed. Data were systematically collected through MEDLINE and EMBASE databases from inception to March 2021. Eligibility criteria included randomized controlled trials performed on patients meeting criteria for difficult catheterization comprising either (a) no palpable or visible veins, (b) previous history of difficult venous catheterization, (c) patient age less than 4 years, (d) suspicion of difficult catheterization by operator, or (e) two or more unsuccessful attempts using the traditional technique before enrollment were included. For all outcomes, a random-effects meta-analysis using the DerSimonian and Laird method was performed. The primary outcome was the first-attempt success rate, and the secondary outcomes were the overall success rate and the number of attempts for successful intravenous catheterization. Bias was assessed using the Revised Cochrane Risk of Bias tool. Seven studies with a total of 994 patients were included. Patients comprised both children and adults and settings included operating rooms, emergency departments, and intensive care units. Ultrasound guidance was associated with a higher first-attempt success rate (OR, 3.07; 95% CI, 1.66–5.65; P < 0.001). For the secondary outcomes, ultrasound guidance was associated with a higher overall success rate (OR, 3.02; 95% CI, 1.04–8.79; P = 0.04); however, this finding did not meet statistical significance in a sensitivity analysis (OR, 2.90; 95% CI, 0.71–11.93; P = 0.14). Ultrasound was not associated with a significantly different number of attempts compared with the traditional technique (difference in means, 0.14; 95% CI, −0.32 to 0.05; P = 0.15). The use of ultrasound guidance resulted in an almost three-fold increase in odds for the first-attempt success rate in patients with predicted DIVA compared with the traditional technique of PIVC. Copyright © 2023 Wolters Kluwer Health, Inc. All rights reserved.