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Ultrasonic locating devices for central venous cannulation: meta-analysis

By D. Hind, N. Calvert, R. McWilliams, A. Davidson, S. Paisley, C. Beverley and S. Thomas

Abstract

OBJECTIVES: To assess the evidence for the clinical\ud effectiveness of ultrasound guided central venous\ud cannulation.\ud DATA SOURCES: 15 electronic bibliographic databases,\ud covering biomedical, science, social science, health\ud economics, and grey literature.\ud DESIGN: Systematic review and meta-analysis of\ud randomised controlled trials.\ud POPULATIONS: Patients scheduled for central venous\ud access.\ud INTERVENTION REVIEWED: Guidance using real time two\ud dimensional ultrasonography or Doppler needles and\ud probes compared with the anatomical landmark\ud method of cannulation.\ud DATA EXTRACTION: Risk of failed catheter placement\ud (primary outcome), risk of complications from\ud placement, risk of failure on first attempt at\ud placement, number of attempts to successful\ud catheterisation, and time (seconds) to successful\ud catheterisation.\ud DATA SYNTHESIS: 18 trials (1646 participants) were\ud identified. Compared with the landmark method, real\ud time two dimensional ultrasound guidance for\ud cannulating the internal jugular vein in adults was\ud associated with a significantly lower failure rate both\ud overall (relative risk 0.14, 95% confidence interval\ud 0.06 to 0.33) and on the first attempt (0.59, 0.39 to\ud 0.88). Limited evidence favoured two dimensional\ud ultrasound guidance for subclavian vein and femoral\ud vein procedures in adults (0.14, 0.04 to 0.57 and 0.29,\ud 0.07 to 1.21, respectively). Three studies in infants\ud confirmed a higher success rate with two dimensional\ud ultrasonography for internal jugular procedures (0.15,\ud 0.03 to 0.64). Doppler guided cannulation of the\ud internal jugular vein in adults was more successful\ud than the landmark method (0.39, 0.17 to 0.92), but the\ud landmark method was more successful for subclavian\ud vein procedures (1.48, 1.03 to 2.14). No significant\ud difference was found between these techniques for\ud cannulation of the internal jugular vein in infants. An\ud indirect comparison of relative risks suggested that\ud two dimensional ultrasonography would be more\ud successful than Doppler guidance for subclavian vein\ud procedures in adults (0.09, 0.02 to 0.38).\ud CONCLUSIONS: Evidence supports the use of two\ud dimensional ultrasonography for central venous\ud cannulation

Year: 2003
OAI identifier: oai:eprints.whiterose.ac.uk:299

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