Related Experiment Video
Updated: May 21, 2026
The Supraclavicular Fossa Ultrasound View for Central Venous Catheter Placement and Catheter Change Over Guidewire
Published on: December 23, 2014
Systematic review: is real-time ultrasonic-guided central line placement by ED physicians more successful than the
Ninfa Mehta1, Walter Wallace Valesky, Allysia Guy
1Department of Emergency Medicine, Kings County Hospital/State University of New York Downstate Medical Center, Brooklyn, New York 11203, USA.
Introduction:
The superiority of ultrasonic-guided compared with landmark-guided central venous catheter (CVC) placement is not well documented in the Emergency Department.
Objective:
To systematically review the literature comparing success rates between ultrasonic- and landmark-guided CVC placement by ED physicians.
Methods:
PubMed and EMBASE databases were searched for randomised controlled trials from 1965 to 2010 using a search strategy derived from the following PICO formulation:
Patients:
Adults requiring emergent CVC placement except during cardiopulmonary resuscitation.
Intervention:
CVC placement using real-time ultrasonic guidance. Comparator: CVC placement using anatomical landmarks.
Outcome:
Comparison of success rates of CVC placement between ultrasonic- versus landmark-guided techniques.
Analysis:
Success rates between CVC placement methods using a Forest Plot (95% CI) calculated by Review Manager Version 5.0.
Results:
Search identified 944 articles of which 938 were excluded by title/abstract relevance, two not randomised, one cardiac arrest, one no landmark control, one success rate not calculated. A single study of 130 patients (65 ultrasonic- vs 65 landmark-guided) selected for internal jugular vein placement remained. Successful internal jugular CVC was significantly (p=0.02) more likely in the ultrasound-guided (93.9%) compared with landmark-guided (78.5%) techniques with an OR of 1.2 (95% CI 1.0 to 1.4). Complications rates were significantly (p=0.04) lower in ultrasonic (4.6%) versus landmark (16.9%) technique, OR=3.7 (95% CI 1.1 to 12.5).
Conclusion:
Only one single high quality study illustrating that ED ultrasound- versus landmark-guided internal jugular catheter placement had higher success rates with lower complication rates.
