Use of ultrasound to place central lines☆
Section snippets
Objectives
The objectives of this article are 2-fold. The first objective is to update prior excellent reviews5, 6 on the relative effectiveness and safety of the use of real-time ultrasound to place CVCs compared with the use of landmarks alone. The second is to use the results of this review to suggest a potential research agenda on the use of these catheters.
Data sources and settings
To identify relevant studies, Medline was searched from 1966 to 2001 using keywords central venous catheter OR internal jugular vein OR subclavian vein OR femoral vein with the restriction of controlled clinical trial. In addition, the references of selected studies were reviewed and 2 former systematic reviews were identified and references reviewed. Finally, for selected studies the option of related articles was also used to identify further trials of interest.
Study design
The clinical question that
Results
After applying the selection criteria to those studies identified by the search strategy, 18 trials were identified for further evaluation,7, 8, 9, 10, 11, 12, 13, 14, 15, 16, 17, 18, 19, 20, 21, 22, 23, 24 17 nonblinded, randomized, controlled trials7, 8, 9, 11, 12, 13, 14, 15, 16, 17, 18, 19, 20, 21, 22, 23, 24 and 1 quasirandomized trial10 conducted in a cardiac catheterization laboratory that allocated the intervention on an alternate week basis. This last trial was accepted because it was
Cost implications
There is an added cost to using either form of ultrasound to guide line placement. For Doppler ultrasound there is the cost of the Doppler unit that is in the range of $800 US. In addition, it requires special needles to allow the probe to be positioned within them. In the study by Bold et al,7 these needles were priced at $40 to $70 US compared with the standard needles at $3 to $5. Portable ultrasound machines with external probes cost approximately $13,000 US. The external probes need to be
Summary of literature review
In summary, the use of ultrasound guidance for placement of CVCs has been extensively studied in the literature but the studies themselves have some methodologic flaws that may bias results (lack of blinding, varying definition of failure). The heterogeneity of results found makes one more cautious in drawing strong inferences from pooled results. However, taking into account the various subgroup analyses, it appears that the use of external ultrasound probes increases the successful placement
Future study
Ultrasound guidance of central line placement is a technology that clearly improves patient safety. However, it is not clear from this systematic review that the added costs of adopting this technology are justified. For those of us working in the ICU, the decision to use this technology requires better evidence that can only be derived from a large, multicenter, randomized, controlled trial of the use of external ultrasound versus landmarks for insertion of CVCs in high-risk ICU patients with
References (25)
- et al.
Ultrasound guidance improves the success rate of internal jugular vein cannulation: A prospective, randomized trial
Chest
(1990) - et al.
Subclavian vein catheterizations: A prospective study. I. Non-infectious complications
Ann Surg
(1971) - et al.
Complications and failures of subclavian-vein catheterization
N Engl J Med
(1994) - et al.
Central vein catheterization: Failure and complication rates by three percutaneous approaches
Arch Intern Med
(1986) - et al.
Doppler localization of the internal jugular vein facilitates central venous cannulation
Anesthesiology
(1984) - et al.
Ultrasound guidance for placement of central venous catheters: A meta-analysis of the literature
Crit Care Med
(1996) Ultrasound Guidance of Central Vein Catheterization
- et al.
Prospective, randomized trial of Doppler-assisted subclavian vein catheterization
Arch Surg
(1998) - et al.
Continuous guidance for venous punctures using a new pulsed Doppler probe: Efficiency, safety
Nephrologie
(1994) - et al.
Pulsed Doppler sonography for guidance of vein puncture: A prospective study
Artif Organs
(1995)
Ultrasound-assisted cannulation of the internal jugular vein: A prospective comparison to the external landmark-guided technique
Circulation
Facilitation of internal jugular venous cannulation using an audio-guided Doppler ultrasound vascular access device: Results from a prospective, dual-center, randomized, crossover clinical study
Crit Care Med
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Address reprint requests to Sean P. Keenan, MD, 103-250 Keary St, New Westminster, British Columbia, Canada, V3L 5E7. E-mail: [email protected].