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Comparing Malposition and Complications Associated with Ultrasound-Guided versus Radiography-Guided Central Catheter
Adel Mohamed, Nada Mohsen1,2, Gonzalo Solis-Garcia3
1Department of Pediatrics, University of Toronto, Toronto, Ontario, Canada.
Neonatology
|April 9, 2025
Summary
Ultrasound-guided central catheter (CC) placement in neonates reduces malposition and the need for X-rays. This systematic review found benefits, but more research is needed to confirm findings.
Area of Science:
- Neonatal medicine
- Medical imaging
- Interventional procedures
Background:
- Central catheter (CC) placement is crucial in neonates.
- Accuracy and complication reduction are key goals for CC tip-positioning.
- Ultrasound guidance is emerging as a potentially superior method.
Purpose of the Study:
- To systematically review and meta-analyze complications of ultrasound-guided versus radiography-guided CC tip-position in neonates.
- To compare malposition rates, radiation exposure, and procedure-related outcomes.
- To assess the certainty of evidence using GRADE methodology.
Main Methods:
- Searched multiple databases (Medline, Cochrane, Embase, CINAHL, clinicaltrials.gov) for RCTs and NRSs up to June 2024.
- Analyzed RCTs and NRSs separately, focusing on outcomes like malposition, X-ray use, procedure time, and sepsis.
- Conducted subgroup meta-analysis by catheter type and used Review Manager 5.4.1 and R 4.1.0 for statistical analysis.
Main Results:
- Included 8 studies (4 RCTs, 4 NRSs) with 1,322 neonates.
- Ultrasound guidance significantly reduced malposition rates (RR: 0.51 in RCTs, 0.25 in NRSs).
- Ultrasound guidance decreased the number of X-rays required (MD: -1.22 in RCTs, -0.31 in NRSs).
- No significant differences observed in procedure time, catheter manipulation, or sepsis rates.
- All evidence was determined to be of low certainty.
Conclusions:
- Ultrasound-guided CC tip-position in neonates is linked to lower malposition rates and reduced radiation exposure.
- The current evidence, though promising, is of low certainty.
- Further research is essential to definitively establish the benefits of ultrasound guidance for CC placement in neonates.
