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Utility of Ultrasound Guidance for Central Venous Access in Children
Chen He1, Rebecca Vieira, Jennifer R Marin
1*Associate Program Director and Assistant Professor (He), Department of Emergency Medicine, Mount Sinai St. Luke's/Mount Sinai West Hospitals, Icahn School of Medicine at Mount Sinai, New York, NY, †Staff Physician and Assistant Professor (Vieira), Division of Emergency Medicine, Boston Children's Hospital; and Departments of Pediatrics and Emergency Medicine, Harvard Medical School, Boston, MA; and ‡Associate Professor (Marin), Departments of Pediatrics and Emergency Medicine, University of Pittsburgh School of Medicine, Pittsburgh, PA.
Insights
Ultrasound (US) guidance for central venous catheter (CVC) placement shows promise in adults, but pediatric data is limited and mixed. Further research is needed to confirm its benefits in pediatric emergency settings.
Area of Science:
- Emergency Medicine
- Pediatric Critical Care
- Medical Ultrasound
Background:
- Central venous catheter (CVC) placement is a critical but challenging procedure in pediatric emergency medicine.
- Ultrasound (US) guidance has demonstrated efficacy in improving CVC placement success in adult populations.
Purpose of the Study:
- To review existing literature on the benefits of US guidance for CVC placement in pediatric emergency departments.
- To evaluate the procedure and current evidence for its application in pediatric patients.
Main Methods:
- Literature review and meta-analysis of studies involving US-guided CVC placement.
- Analysis of adult and pediatric data, including emergency department settings.
Main Results:
- Adult studies consistently show US guidance reduces CVC placement failure, complications, and attempts.
- Pediatric data is sparse, with some studies suggesting benefits and others showing no significant difference compared to landmark techniques.
Conclusions:
- US guidance is supported for adult CVC placement, but pediatric evidence remains inconclusive due to limited research.
- Increased adoption of point-of-care US in pediatric emergency medicine is expected to generate more robust data.
Background:
Placement of a central venous catheter (CVC) in a pediatric patient is an important skill for pediatric emergency medicine physicians but can be challenging and time consuming. Ultrasound (US) guidance has been shown to improve success of central line placement in adult patients.
Objectives:
This article aims to review the literature and evaluate the benefit of US guidance in the placement of CVCs, specifically in pediatric emergency department patients, and to review the procedure.
Results:
Four meta-analyses of US-guided CVC placement in adult patients concluded that US guidance reduces placement failure, decreases complications, and decreases the need for multiple attempts. Two studies in the emergency department setting support these conclusions. Pediatric-specific data related to US-guided CVC placement include data suggesting a benefit with US guidance, as well as data indicating no difference in outcome measures when US guidance is used compared with the landmark technique.
Conclusions:
The evidence surrounding US-guided CVC insertion supports its use in adult patients. Pediatric-specific literature is sparse and includes mixed results. As more pediatric emergency physicians adopt the use of point-of-care US, we expect an increase in data supporting its use for CVC placement in pediatric emergency department patients.
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