Ultrasound-Guided vs. Landmark Method for Subclavian Vein Catheterization in an Academic Emergency Department

Subramony, Rachna; Spann, Rachel; Medak, Anthony J.; Campbell, Colleen

doi:10.1016/j.jemermed.2021.11.002

Cited by 4 publications

(10 citation statements)

References 7 publications

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“…Three studies provided description of the operator’s level of experience in ultrasound-guided SCV cannulation (16, 20, 21), which was highly variable. Three studies assessed real-time long-axis (in plane) ultrasound-guided cannulation (16, 18, 21); the remainder consisted of short-axis (out of plane) cannulation (13, 17, 19).…”

Section: Resultsmentioning

confidence: 99%

“…The risk of bias assessments identified one RCT with a high risk of bias (16); the other studies were assessed to be low-risk ( Supplementary Digital Content 5 , http://links.lww.com/CCM/H300). The nature of the intervention precludes practitioner blinding, blinding of outcome assessment, and allocation concealment.…”

Section: Resultsmentioning

confidence: 99%

“…Five studies were included in the sensitivity analysis: two RCTs based on static ultrasound guidance (14,20), one prospective study [15]), and two retrospective studies (31,32). The remaining six RCTs (13,(16)(17)(18)(19)21) were included in the quantitative analysis; their characteristics are reported in Table 1.…”

Section: Resultsmentioning

confidence: 99%

“…The majority of the included studies recruited ICU patients (13,(17)(18)(19)21), although only one study by Fragou et al (18) specified that all patients were mechanically ventilated during cannulation. Three studies provided description of the operator's level of experience in ultrasound-guided SCV cannulation (16,20,21), which was highly variable. Three studies assessed real-time long-axis (in plane) ultrasound-guided cannulation (16,18,21); the remainder consisted of shortaxis (out of plane) cannulation (13,17,19).…”

Section: Resultsmentioning

confidence: 99%

“…The definition of cannulation attempt was not standardized across the studies, with three studies regarding skin puncture as an attempt (17, 19, 21) and two studies also regarding needle withdrawal as an attempt (17, 21). Most of the included studies were single-center studies with small sample sizes and a limited number of operators; only four studies mentioned the operator experience in ultrasound-guided SCV cannulation (15, 16, 21). Regarding access time, only three studies reported this figure and method of measurement (17, 18, 21).…”

Section: Discussionmentioning

confidence: 99%

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Real-Time Ultrasound Guidance as Compared With Landmark Technique for Subclavian Central Venous Cannulation: A Systematic Review and Meta-Analysis With Trial Sequential Analysis*

Zawadka

Via

Wong

et al. 2023

Critical Care Medicine

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OBJECTIVES:We conducted a systematic review and meta-analysis to assess the effectiveness of real-time dynamic ultrasound-guided subclavian vein cannulation as compared to landmark technique in adult patients.DATA SOURCES: PubMed and EMBASE until June 1, 2022, with the EMBASE search restricted to the last 5 years. STUDY SELECTION:We included randomized controlled trials (RCTs) comparing the two techniques (real-time ultrasound-guided vs landmark) for subclavian vein cannulation. The primary outcomes were overall success rate and complication rate, whereas secondary outcomes included success at first attempt, number of attempts, and access time.DATA EXTRACTION: Independent extraction by two authors according to prespecified criteria.DATA SYNTHESIS: After screening, six RCTs were included. Two further RCTs using a static ultrasound-guided approach and one prospective study were included in the sensitivity analyses. The results are presented in the form of risk ratio (RR) or mean difference (MD) with 95% CI. Real-time ultrasound guidance increased the overall success rate for subclavian vein cannulation as compared to landmark technique (RR = 1.14; [95% CI 1.06-1.23]; p = 0.0007; I 2 = 55%; low certainty) and complication rates (RR = 0.32; [95% CI 0.22-0.47]; p < 0.00001; I 2 = 0%; low certainty). Furthermore, ultrasound guidance increased the success rate at first attempt (RR = 1.32; [95% CI 1.14-1.54]; p = 0.0003; I 2 = 0%; low certainty), reduced the total number of attempts (MD = -0.45 [95% CI -0.57 to -0.34]; p < 0.00001; I 2 = 0%; low certainty), and access time ; p = 0.006; I 2 = 77%; low certainty). The Trial Sequential Analyses on the investigated outcomes showed that the results were robust. The evidence for all outcomes was considered to be of low certainty. CONCLUSIONS:Real-time ultrasound-guided subclavian vein cannulation is safer and more efficient than a landmark approach. The findings seem robust although the evidence of low certainty.

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Section: Resultsmentioning

confidence: 99%

Section: Resultsmentioning

confidence: 99%

Section: Resultsmentioning

confidence: 99%

Section: Resultsmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

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Real-Time Ultrasound Guidance as Compared With Landmark Technique for Subclavian Central Venous Cannulation: A Systematic Review and Meta-Analysis With Trial Sequential Analysis*

Zawadka

Via

Wong

et al. 2023

Critical Care Medicine

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Ultrasound-Guided Cannulation

Slama,

Zerbib,

Brault

et al. 2023

Lessons From the ICU

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Ultrasound-guided subclavian vein catheterisation with a needle guide (ELUSIVE): protocol for a randomised controlled study

Naddi,

Borgquist,

Adrian

et al. 2023

BMJ Open

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IntroductionCentral venous catheters are indispensable in modern healthcare. Unfortunately, they are accompanied by minor as well as major complications, leading to increased morbidity, mortality and costs. Immediate insertion-related complications (mechanical complications) have decreased due to the implementation of real-time ultrasound guidance, but they still occur and additional efforts to enhance patient safety are warranted. This study aims to investigate whether the use of a needle guide mounted on the ultrasound probe in subclavian catheterisations may decrease the number of catheterisations with >1 skin puncture (primary outcome).Methods and analysisThis is an investigator-initiated, non-commercial, randomised, controlled, parallel-group study conducted at Skåne University Hospital, Lund, Sweden. Adults (≥18 years) with a clinical indication for a subclavian central venous catheter and the ability to give written informed consent will be eligible for inclusion. Exclusion criteria include subclavian catheterisation deemed unsuitable based on the preprocedural ultrasound examination. Patients will be randomised to catheterisation by certified operators using a microconvex probe (long-axis, in-plane technique) with (n=150) or without (n=150) a needle guide. The ultrasound imaging from the procedures will be recorded and assessed by two reviewers individually. The assessors will be blinded for group affiliation. Secondary outcomes include the total number of skin punctures, mechanical complications, time to successful venous puncture, number of failed catheterisations and operator satisfaction with the needle guide at the end of the study period.Recruitment started on 8 November 2022 and will continue until the sample size is achieved.Ethics and disseminationThis study was approved by the Swedish Ethical Review Authority (#2022-04073-01) and the Swedish Medical Products Agency (#5.1-2022-52130; CIV-21-12-038367). The findings will be submitted to an international peer-reviewed journal.Trial registration numberNCT05513378, clinicaltrials.gov.

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Ultrasound-Guided vs. Landmark Method for Subclavian Vein Catheterization in an Academic Emergency Department

Cited by 4 publications

References 7 publications

Real-Time Ultrasound Guidance as Compared With Landmark Technique for Subclavian Central Venous Cannulation: A Systematic Review and Meta-Analysis With Trial Sequential Analysis*

Real-Time Ultrasound Guidance as Compared With Landmark Technique for Subclavian Central Venous Cannulation: A Systematic Review and Meta-Analysis With Trial Sequential Analysis*

Ultrasound-Guided Cannulation

Ultrasound-guided subclavian vein catheterisation with a needle guide (ELUSIVE): protocol for a randomised controlled study

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