Ultrasound-guided or landmark techniques for central venous catheter placement in critically ill children
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To assess whether ultrasound guidance improves central venous catheter placement outcomes compared to the landmark technique in critically ill children.
A prospective multicentre observational study was carried out in 26 paediatric intensive care units over 6 months. Children 0–18 years old who received a temporary central venous catheter, inserted using either ultrasound or landmark techniques, were eligible. The primary outcome was the first-attempt success rate. Secondary outcomes included overall placement success, number of puncture attempts, number of procedures requiring multiple punctures (> 3 punctures), number of procedures requiring punctures at more than one vein site and immediate mechanical complications. To account for potential confounding factors, we used propensity scores. Our primary analysis was based on 1:1 propensity score matching. The association between cannulation technique and outcomes in the matched cohort was estimated using generalized estimating equations and mixed-effects models to account for patient-level and hospital-level confounders.
Five hundred central venous catheter-placement procedures involving 354 patients were included. Ultrasound was used for 323 procedures, and the landmark technique was used for 177. Two hundred and sixty-six procedures were matched (133 in the ultrasound group and 133 in the landmark group). Ultrasound was associated with an increase in the first-attempt success rate [46.6 vs. 30%, odds ratio 2.09 (1.26–3.46); p < 0.001], a reduced number of puncture attempts [2 (1–3) vs. 2 (1–4), B coefficient − 0.51 (95% confidence interval − 1.01 to − 0.03), p = 0.035], and fewer overall mechanical complications [12 vs. 22.5%, odds ratio 0.47 (95% confidence interval 0.24–0.91), p = 0.025] in the matched cohort. The number of puncture attempts was the main factor associated with overall complications.
Compared with the landmark technique, ultrasound guidance was associated with an increased first-attempt success rate, a reduced number of puncture attempts, and fewer complications during central venous catheter placement in critically ill children.
KeywordsUltrasound Landmark Central venous catheterization Paediatric intensive care unit Children
The authors wish to thank all the collaborators for their participation in the RECANVA study.
RECANVA collaborative study. Other members of the RECANVA collaborative study are: Manuel Ortiz-Pallares. Paediatric Intensive Care Unit. Hospital Universitario Alvaro Cunqueiro. Estrada Clara Campoamor, 341, 36212 Vigo. (Spain)a, Emilia Fernández-Romero. Paediatric Intensive Care Unit. Hospital Universitario Virgen de la Macarena. Avenida Doctor Fedriani, 3, 41009 Sevilla (Spain)a, Soledad Torrús-Carmona. Paediatric and Neonatal Intensive Care Unit. Complejo Hospitalario de Navarra. Calle de Irunlarrea, 3, 31008 Pamplona (Spain)a, Alicia Mirás-Veiga. Paediatric Intensive Care Unit. Hospital Universitario de Burgos. Avda. Islas Baleares, 3, 09006 Burgos (Spain)a,b, María García-Barba. Paediatric Intensive Care Unit. Hospital Universitario Monte Príncipe. Av. de Montepríncipe, 25, 28660 Boadilla del Monte. (Spain)a, Esther Jimenez. Paediatric Intensive Care Unit. Hospital Universitari de Girona Doctor Josep Trueta. Avinguda de França, S/N, 17007 Girona. (Spain)a, María Pino-Velázquez. Paediatric Intensive Care Unit. Hospital Clínico Universitario de Valladolid. Av. Ramón y Cajal, 3, 47003 Valladolid (Spain)a, Virginia González-Ojeda. Paediatric Intensive Care Unit. Hospital Universitario Quirón-Salud. Calle Diego de Velázquez, 1, 28223 Pozuelo de Alarcón, (Spain)a, Amalia Martínez-Antón. Paediatric Intensive Care Unit. Hospital Universitario Fundación Jiménez Díaz. Av. Reyes Católicos, 2, 28040 Madrid (Spain)a, Carolina González-Miño. Paediatric Intensive Care Unit. Hospital General de Castellón. Avinguda de Benicàssim, s/n, 12004 Castelló de la Plana, (Spain)a.
aRECANVA collaborative study.
bWorking Group on Bedside Ultrasound of the Spanish Society of Pediatric Intensive Care.
Compliance with ethical standards
Conflicts of interest
The authors declare that they have no conflict of interest.
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