Authors' objectives:

The aim of this study was to investigate the clinical and cost-effectiveness of ultrasonic locating devices (ULD) for central venous access (CVA).

Authors' results and conclusions: Twenty RCTs of variable methodological quality were identified. Sample sizes were generally small. A total of 13 studies addressed 2-D US versus landmark procedures. Eight studies addressed internal jugular vein (IJV) venepuncture, one subclavian vein (SV) insertions, and one femoral vein (FV) insertions: all ten of these were in adults. Two studies analysed IJV insertions in infants. One reported neither the age of the population nor the insertion site. Six studies addressed Doppler US versus landmark, all in adults. In three of these studies, the insertion site was the IJV while in two it was the SV. One RCT had four arms, comparing Doppler US and landmark for insertion in both the IJV and the SV. Only one very small study compared 2-D US, Doppler US and landmark for the venepuncture of infants through the IJV. The trial evidence suggests that 2-D US is significantly better than landmark for all five outcome variables measured for insertions into the IJV in adults. The results also favour 2-D US for insertions into the SV and FV in adults, although based on only one RCT each. For the three infant studies addressing insertion into the IJV, the results again suggest that 2-D US has a statistically significant beneficial effect. For Doppler US, only insertions into the IJV in adults, reported in four RCTs, indicated improved failure and complication rates over landmark. The other three Doppler US RCTs for SV insertions in adults and IJV insertions in children provide little support for Doppler over landmark methods. For clinically experienced operators, proficient with the landmark method, Doppler US increased the number of failed catheter placements in attempts to catheterise the SV. The extent to which it is possible to generalise from these results for Doppler US is unclear.

Authors' recommendations: There is evidence for the effectiveness and cost-effectiveness of 2-D US-guided CVA, particularly via the IJV in adults and children. However, some important implications of possible wider use of 2-D US for CVA are clearly identifiable.

Authors' methods: Systematic review, Economic evaluation

Project Status: Completed

URL for project: http://www.hta.ac.uk/1261

Year Published: 2003

English language abstract: An English language summary is available

Publication Type: Not Assigned

Country: England, United Kingdom

Organisation Name: NIHR Health Technology Assessment programme

Contact Address: NIHR Journals Library, National Institute for Health and Care Research, Evaluation, Trials and Studies Coordinating Centre, Alpha House, University of Southampton Science Park, Southampton SO16 7NS, UK

Contact Name: journals.library@nihr.ac.uk

Contact Email: journals.library@nihr.ac.uk

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