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Published on: December 23, 2014
Ultrasound Guidance for Pediatric Central Venous Catheterization: A Meta-analysis
Tiago Henrique de Souza1, Marcelo Barciela Brandão2, José Antonio Hersan Nadal2
1Division of Pediatric Critical Care, Department of Pediatrics, University of Campinas, Campinas, São Paulo, Brazil; and tiago.souza@hc.unicamp.br.
Insights
Ultrasound guidance significantly reduces central venous catheterization failures and arterial punctures in critically ill children. This method is safer and more effective than traditional landmark techniques for pediatric patients.
Area of Science:
- Pediatric critical care medicine
- Medical imaging in pediatrics
- Interventional procedures in children
Background:
- Central venous catheterization is essential for critically ill pediatric patients.
- The procedure can be challenging due to pediatric anatomical characteristics.
- Associated morbidity includes procedure failure and complications like arterial puncture.
Purpose of the Study:
- To compare the efficacy and safety of ultrasound-guided central venous catheterization versus the anatomic landmark technique in children.
- To determine if ultrasound guidance reduces failure rates and complications.
Main Methods:
- Systematic search of PubMed and Embase databases.
- Inclusion of randomized controlled trials and nonrandomized studies comparing ultrasound guidance with landmark techniques in pediatric central venous catheterization.
- Meta-analysis using random-effects models to pool outcomes.
Main Results:
- Ultrasound guidance significantly decreased cannulation failure by 73% (OR=0.27).
- Ultrasound guidance significantly reduced arterial punctures by 66% (OR=0.34).
- These benefits were consistent across different venous sites (femoral, internal jugular).
Conclusions:
- Ultrasound-guided central venous catheterization is superior to the landmark technique in pediatric patients.
- This technique improves procedural success rates and minimizes complications.
- It is recommended for pediatric central venous catheterization to enhance patient safety.
Abstract:
: media-1vid110.1542/5828324804001PEDS-VA_2018-1719Video Abstract CONTEXT: Central venous catheterization is routinely required in patients who are critically ill, and it carries an associated morbidity. In pediatric patients, the procedures can be difficult and challenging, predominantly because of their anatomic characteristics.
Objective:
To determine whether ultrasound-guided techniques are associated with a reduced incidence of failures and complications when compared with the anatomic landmark technique.
Data Sources:
We conducted a systematic search of PubMed and Embase.
Study Selection:
We included randomized controlled trials and nonrandomized studies in which researchers compare ultrasound guidance with the anatomic landmark technique in children who underwent central venous catheterization.
Data Extraction:
Study characteristics, sample sizes, participant characteristics, settings, descriptions of the ultrasound technique, puncture sites, and outcomes were analyzed. Pooled analyses were performed by using random-effects models.
Results:
A total of 23 studies (3995 procedures) were included. Meta-analysis revealed that ultrasound guidance significantly reduced the risk of cannulation failure (odds ratio = 0.27; 95% confidence interval: 0.17-0.43), with significant heterogeneity seen among the studies. Ultrasound guidance also significantly reduced the incidence of arterial punctures (odds ratio = 0.34; 95% confidence interval: 0.21-0.55), without significant heterogeneity seen among the studies. Similar results were observed for femoral and internal jugular veins.
Limitations:
Potential publication bias for cannulation failure and arterial puncture was detected among the studies. However, no publication bias was observed when analyzing only the subgroup of randomized clinical trials.
Conclusions:
Ultrasound-guided techniques are associated with a reduced incidence of failures and inadvertent arterial punctures in pediatric central venous catheterization when compared with the anatomic landmark technique.
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