Ultrasound-guided versus open surgical central venous access in children: A systematic review

Central venous catheters (CVCs) are essential in pediatric care for long-term venous access. While tunneled CVCs have traditionally been placed using open surgical venotomy or cut-down (OS), ultrasound-guided (USG) percutaneous insertion is widely used. However, no systematic review has yet evaluated pediatric evidence directly comparing both approaches. We conducted a systematic review of randomized controlled trials (RCTs) comparing USG and OS placement of CVCs in patients younger than 18 years. PubMed, EMBASE, and the Cochrane Central Register of Controlled Trials were searched until September 2025. The primary outcome was successful catheter placement; secondary outcomes included infection, thrombosis, venous diameter after catheter removal, and procedure duration. Five RCTs with 587 children were included. Placement success was comparable between techniques (97.5% USG vs. 95.7% OS; RR 1.00, 95% CI 0.96-1.05; moderate-certainty evidence). Infection rates did not differ significantly. USG was associated with a significantly lower risk of thrombosis (RR 0.34, 95% CI 0.14-0.82), consistently shorter procedure times, and better preservation of venous diameter, although the certainty of evidence for these outcomes was very low. USG placement achieves comparable success to OS but may offer procedural and vessel-preservation benefits.