Table 21.1. Ultrasound and Doppler ultrasound guidance of central vein catheters*

Study Setting and PopulationYear PublishedInterventionStudy Design, OutcomesRelative Risk Reduction (%)**
Failed Catheter InsertionMean Insertion Attempts Required§ Complications
Ultrasound
Doppler Ultrasound
Tertiary care, teaching hospital ICU 13 1990US guidance for IJ CVC insertion without needle guide; concurrent feedback from an US technicianLevel 1 Level 2100NS 44NA
Tertiary care, teaching hospital, CT surgical patients 14 1991US guidance (7.5 and 5.0 MHz transducers) for IJ CVC insertion without needle guideLevel 1 Level 21004483NS
Tertiary care, teaching hospital, cardiac patients 11 1993US guidance (7.5 MHz transducer) of IJ cannulation for cardiac catheterization and CVC insertion, with needle guideLevel 1 Level 21004880
Urban, teaching hospital ICU 12 1995US guidance (7.5 MHz transducer) for SC CVC insertion with needle guideLevel 1 Level 2864890
Urban, teaching hospital ED, during CPR 15 1997US guidance (7.5 MHz transducer) for femoral CVC insertion without needle guideLevel 1 Level 27154100
Tertiary care, teaching hospital, CT/ vascular surgery patients 8 1994Doppler US guidance of IJ CVC insertion with probe in the needleLevel 1 Level 20520
British hospital, cardiac surgery and ICU patients 10 1994Doppler US guidance of IJ CVC insertion with probe in the needleLevel 1 Level 2−50NS 17NS 0
Tertiary care, teaching hospital ICU and OR; high-risk patients 6 1995Audio-guided Doppler US guidance for IJ CVC insertion with probe in the needleLevel 1 Level 26318NS 88
French teaching hospital ICU; low-risk patients 17 1998Pulsed Doppler US guidance for SC CVC insertion without needle guideLevel 1 Level 2−32§ 067
Tertiary care, outpatient oncology center 9 1998Doppler US guidance for SC CVC insertion with probe in the needle-46§ NA-53NS

*CPR indicates cardiopulmonary resuscitation; CT, cardiothoracic; ED, emergency department; ICU, intensive care unit; IJ, internaljugular vein; NA, not available; NS, not statistically significant; OR, operating room; RCT, randomized controlled trial; SC, subclavian vein; and US, ultrasound guidance.

**The percentage relative risk reduction reflects the risks associated with CVC placement and the percentage change resulting from US guidance. Negative values indicate an increase in risks associated with US guidance.

§Relative risk reduction of the insertion attempts to success reflects the relative reduction in the mean number of needle insertions attempted per patient until successful CVC placement resulting from US guidance.

From: 21, Ultrasound Guidance of Central Vein Catheterization

Cover of Making Health Care Safer
Making Health Care Safer: A Critical Analysis of Patient Safety Practices.
Evidence Reports/Technology Assessments, No. 43.
Shojania KG, Duncan BW, McDonald KM, et al., editors.

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