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Published on: December 23, 2014
Different axis approaches for ultrasound-guided centrally inserted central catheterization in children: a systematic
In Kyung Lee1,2, Kyeong Hun Lee1, Hye-Ji Han3
1Department of Pediatrics, Seoul St. Mary's Hospital, Seoul, Republic of Korea.
Insights
The long-axis approach for ultrasound-guided central venous catheterization in children reduces procedure time and complications. This method offers improved safety and efficiency compared to the short-axis approach for pediatric central line placement.
Area of Science:
- Pediatric critical care medicine
- Medical imaging in pediatrics
- Vascular access procedures
Background:
- Centrally inserted central catheterization (CICC) in children presents unique challenges due to anatomical and physiological differences, leading to higher complication rates than in adults.
- Ultrasound guidance improves CICC safety and efficacy, but optimal axis approaches require further investigation.
- Comparative data on different ultrasound-guided CICC axis approaches in pediatric populations are limited.
Purpose of the Study:
- To systematically review and meta-analyze randomized controlled trials comparing different axis approaches for ultrasound-guided CICC in children.
- To evaluate the impact of different axis approaches on success rates, cannulation time, and complication incidence.
Main Methods:
- A systematic review and meta-analysis of randomized controlled trials were conducted.
- Searches were performed in relevant databases up to June 10, 2024, including six studies for the review and three for the meta-analysis.
- Primary outcomes included first-attempt success rate, overall success rate, and cannulation time; secondary outcomes were complications like hematoma and posterior wall puncture.
Main Results:
- Analysis of data from 547 children indicated the long-axis in-plane approach significantly reduced cannulation time (MD -27.48s) and overall complications (OR 0.21) compared to the short-axis out-of-plane approach.
- No significant differences were observed in first-attempt or overall success rates between the long-axis and short-axis approaches.
- The long-axis approach demonstrated a notable reduction in procedural complications.
Conclusions:
- The long-axis approach for ultrasound-guided CICC in children is advantageous, significantly decreasing cannulation time and complication rates.
- While the dynamic needle tip positioning method shows potential, further research is necessary to confirm its clinical efficacy.
- Refinement of these ultrasound-guided techniques and their application in varied clinical settings warrants further investigation.
Background:
Centrally inserted central catheterization (CICC) is a critical procedure in pediatric care. However, CICC in children poses greater challenges compared to adults due to anatomical and physiological differences, leading to higher complication rates. Ultrasound-guided approaches have been developed to enhance the safety and effectiveness of CICC, but the comparative efficacy of different axis approaches remains unclear.
Methods:
A systematic review and meta-analysis of randomized controlled trials comparing different axis approaches for ultrasound-guided CICC in children was conducted. Searches were carried out in databases up to June 10, 2024. Six studies were included in the systematic review and three studies were included in the meta-analysis. Primary outcomes included first-attempt success rate, overall success rate, and cannulation time. Secondary outcomes were complications such as hematoma and posterior wall puncture.
Results:
Data from 547 children were analyzed. The long-axis in-plane approach significantly reduced cannulation time (MD -27.48 s, 95% CI, -33.99 to -20.97) and overall complications OR 0.21, 95% CI, 0.1-0.48) compared to short-axis out-of-plane approach. No significant differences were found in first-attempt or overall success rates between the long-axis and short-axis approaches.
Conclusion:
The long-axis approach for ultrasound-guided CICC in children offers significant advantages in reducing cannulation time and complications. While dynamic needle tip positioning method may serve as an alternative to in-plane methods, further studies are needed to validate its clinical efficacy. Further research is needed to refine these techniques and explore their application in diverse clinical settings.
