Ultrasound guidance or landmark technique for CVAD insertion?
A Cochrance review (Brass et al, 2015) found that two-dimensional ultrasound offers small gains in safety and quality when compared with an anatomical landmark technique for subclavian (arterial puncture, haematoma formation) or femoral vein (success on the first attempt) cannulation for central vein catheterization. Data on insertion by inexperienced or experienced users, or on patients at high risk for complications, are lacking. The results for Doppler ultrasound techniques versus anatomical landmark techniques are uncertain.
Lau and colleagues (2016) found that US-guided CVC placement for pediatrics is associated with significantly higher success rates and decreased mean number of attempts required for cannulation. US-guided CVC insertion improves success rates, and should be utilized in pediatric patients.
Brass P, Hellmich M, Kolodziej L, Schick G, Smith AF. Ultrasound guidance versus anatomical landmarks for subclavian or femoral vein catheterization. Cochrane Database of Systematic Reviews 2015, Issue 1. Art. No.: CD011447. DOI:10.1002/14651858.CD011447. http://www.ncbi.nlm.nih.gov/pubmed/25575245
Lau CS, Chamberlain RS. Ultrasound-guided central venous catheter placement increases success rates in pediatric patients: a meta-analysis. Pediatric Research 2016, volume 80, pages 178-184. doi:10.1038/pr.2016.7410.1038/pr.2016.74. http://www.nature.com/pr/journal/vaop/ncurrent/full/pr201674a.html