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This month’s update is by the School of Health and Related Research team in Sheffield. We used a multimodal search strategy, drawing on free open-access medical education resources and literature searches. We identified the five most interesting and relevant papers (decided by consensus) and highlight the main findings, key limitations and clinical bottom line for each paper.
The papers are ranked as
Worth a peek—interesting, but not yet ready for prime time.
Head turner—new concepts.
Game changer—this paper could/should change practice.
Ultrasound guidance versus landmark method for peripheral venous cannulation in adults by Tada et al
Topic: ultrasound guided cannulation
Outcome rating: worth a peek
The efficacy of ultrasound to guide placement of centrally placed lines has been established, whereas for peripheral lines, this is not the case.1
This systematic review and meta-analysis aimed to evaluate the effectiveness of ultrasound guidance for peripheral cannulation in adult patients. The review followed established Cochrane methodology. Results were presented as three subgroups defined by the perceived difficulty in placing a cannula using the landmark method: difficult, moderately difficult or easy. The intervention’s efficacy was expected to depend on the difficulty level.
The authors identified 16 randomised controlled trials (RCTs) and quasi-RCTs for inclusion in the final analysis. For difficult-to-cannulate patients, ultrasound increased the success of first-pass cannulation (risk ratio (RR) 1.50, 95% CI 1.15 to 1.95) (low-certainty evidence) with no difference in pain (mean difference (MD) 0.20, 95% CI 1.13 to 0.72) (very low certainty). For moderately difficult patients, first-time success was also increased but to a lesser extent (RR 1.14, 95% CI 1.02 to 1.27) (moderate certainty), again with no difference in pain (MD 0.10, 95% CI 0.47 TO 0.67) (low certainty). However, in easy-to-cannulate patients, first-time success decreased (RR 0.89, 95% CI 0.85 to 0.94) (high certainty) and reported pain increased (MD 0.60, 95% CI 0.17 to 1.03) (moderate certainty).
The results of this meta-analysis should …
Twitter @drsusiec, @MikeTonkins
Contributors HC: initial article search, organisation of team, literature review, article selection and editing. FS, SC, JL, MW and AR: literature review, article selection, critical appraisal and article summary. MT: critical appraisal and article summary. GP: editing of the article, organisation of team and article selection.
Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.
Competing interests None declared.
Provenance and peer review Not commissioned; internally peer reviewed.