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Paper

Ultrasonic locating devices for central venous cannulation: meta-analysis

BMJ 2003; 327 doi: https://doi.org/10.1136/bmj.327.7411.361 (Published 14 August 2003) Cite this as: BMJ 2003;327:361
  1. Daniel Hind, research associate (d.hind{at}shef.ac.uk)1,
  2. Neill Calvert, consultant2,
  3. Richard McWilliams, consultant radiologist3,
  4. Andrew Davidson, consultant anaesthetist4,
  5. Suzy Paisley, managing director ScHARR Rapid Reviews Group1,
  6. Catherine Beverley, information officer1,
  7. Steven Thomas, senior lecturer5
  1. 1 School of Health and Related Research (ScHARR), Regent Court, Sheffield S1 4DA
  2. 2 Fourth Hurdle Consulting, London WC1R 4QA
  3. 3 Royal Liverpool University Hospital, Liverpool L7 8XP
  4. 4 Sheffield Teaching Hospitals NHS Trust, Royal Hallamshire Hospital, Sheffield S10 2JF
  5. 5 Department of Academic Radiology, University of Sheffield, Northern General Hospital, Sheffield S5 7AU
  1. Correspondence to: D Hind
  • Accepted 18 June 2003

Abstract

Objectives To assess the evidence for the clinical effectiveness of ultrasound guided central venous cannulation.

Data sources 15 electronic bibliographic databases, covering biomedical, science, social science, health economics, and grey literature.

Design Systematic review and meta-analysis of randomised controlled trials.

Populations Patients scheduled for central venous access.

Intervention reviewed Guidance using real time two dimensional ultrasonography or Doppler needles and probes compared with the anatomical landmark method of cannulation.

Data extraction Risk of failed catheter placement (primary outcome), risk of complications from placement, risk of failure on first attempt at placement, number of attempts to successful catheterisation, and time (seconds) to successful catheterisation.

Data synthesis 18 trials (1646 participants) were identified. Compared with the landmark method, real time two dimensional ultrasound guidance for cannulating the internal jugular vein in adults was associated with a significantly lower failure rate both overall (relative risk 0.14, 95% confidence interval 0.06 to 0.33) and on the first attempt (0.59, 0.39 to 0.88). Limited evidence favoured two dimensional ultrasound guidance for subclavian vein and femoral vein procedures in adults (0.14, 0.04 to 0.57 and 0.29, 0.07 to 1.21, respectively). Three studies in infants confirmed a higher success rate with two dimensional ultrasonography for internal jugular procedures (0.15, 0.03 to 0.64). Doppler guided cannulation of the internal jugular vein in adults was more successful than the landmark method (0.39, 0.17 to 0.92), but the landmark method was more successful for subclavian vein procedures (1.48, 1.03 to 2.14). No significant difference was found between these techniques for cannulation of the internal jugular vein in infants. An indirect comparison of relative risks suggested that two dimensional ultrasonography would be more successful than Doppler guidance for subclavian vein procedures in adults (0.09, 0.02 to 0.38).

Conclusions Evidence supports the use of two dimensional ultrasonography for central venous cannulation.

Footnotes

  • Embedded Image Additional references appear on bmj.com

  • Contributors DH and NC designed the review, screened search results, screened retrieved papers against inclusion criteria, appraised quality of papers, abstracted data from papers, analysed data, provided a methodological perspective in the interpretation of data, and wrote the review. RMcW and AD obtained and screened data on unpublished studies, provided a clinical perspective in the interpretation of data, provided general advice on the review, and wrote the review. SP coordinated the review, provided general advice on the review, and secured funding. CB designed the review, developed the search strategy, undertook searches, organised retrieval of papers, and wrote the review. ST provided a clinical perspective in the interpretation of data, provided general advice on the review, and wrote the review. KB, nurse consultant in critical care medicine (Sheffield Teaching Hospitals NHS Trust), provided a clinical perspective in the interpretation of data and provided general advice on the review.

  • Funding The UK National Coordinating Centre for Health Technology Assessment programme funded the study.

  • Competing interests RMcW has received honorariums from Sonosite for lecturing at training days.

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