Ultrasound Prelocation Superior to Real-Time Ultrasound Guidance for Paediatric Venous Catheterisation: Presented at ISICEM

By Chris Berrie

BRUSSELS, Belgium -- March 26, 2018 -- Ultrasound (US)-assisted vein prelocation (US prelocation) is superior to real-time US guidance (real-time US) for percutaneous central venous catheterisation in paediatric patients, according to a study presented here at the 38th International Symposium on Intensive Care and Emergency Medicine (ISICEM).

Both of the US-based methods achieve lower rates of failure and arterial puncture than the surface anatomical landmark method, which they can now replace.

“There is a shortage of evidence [for the optimal technique], with no large randomised controlled trials, so we have to do meta-analyses,” said Koji Hosokawa, MD, PhD, Department of Emergency and Critical Care Medicine, Hiroshima University, Hiroshima, Japan, on March 20.

The researchers sought to determine which of the US-based methods is superior in paediatric patients according to available randomised controlled trials. They performed conventional and frequentist meta-analyses.

Eleven randomised controlled trials (935 patients) were included. The interior jugular vein was the main puncture site (n = 803), but femoral vein (n = 48) and supraclavicular vein (n = 84) were also used.

Failure rates of catheterisation in the conventional meta-analysis (7 trials, n = 709) indicated that real-time US was significantly superior to the landmark method (27 and 89 events; odds ratio [OR], 0.28; P = .00001). US prelocation (3 trials) was also significantly superior to the landmark method (n = 166; 1 and 23 events; OR, 0.06; P = .0003).

In the single trial comparing the US methods (n = 60), real-time US was significantly superior to US prelocation for failure rates of catheterisation (0 and 7 events; OR, 0.04; P = .03).

For arterial puncture in the conventional meta-analyses, real-time US guidance was significantly superior to the landmark method (15 and 60 events; odds ratio [OR], 0.27; P = .00001). Again, US prelocation was significantly superior to the landmark method (2 and 10 events; OR, 0.16; P = .02).

However, for arterial puncture in the single trial comparing US methods, no significant difference was found between real-time US and US prelocation (n = 60; 0 and 1 event; OR, 0.26; P = .42).

The network meta-analysis then provided an indirect comparison of the 2 US-based methods. In relation to the landmark method (OR, 1.00), the p-scores for cannulation failure were lower for real-time US (p-score, 0.61; OR, 0.28) than for US prelocation (p-score, 0.88; OR, 0.17). The same was true for arterial puncture (p-score, 0.64; OR, 0.44; and p-score, 0.83; OR, 0.28, respectively).

Therefore, based on these p-scores of the network analysis, US-assisted prelocation appears to be superior to real-time US guidance, concluded Dr. Hosokawa. The researchers speculated that this arises from the difficulty for real-time US in needle puncture together with manipulation of the echo probe, which relates to the small vessels in paediatric patients.

[Presentation title: Real-Time Guidance or Prelocation Using Ultrasound for Pediatric Central Venous Catheterization; A Systematic Review and Network Meta-Analysis. Abstract 133]

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