Authors' objectives: What is the clinical effectiveness of POCUS for CVC insertion requiring imaging, localization, and placement compared to CVC placement using the LM? What evidence-based guidelines are available related to the use of POCUS for CVC insertion requiring imaging, localization, and placement? 

Authors' results and conclusions: What is the Issue? Conventional central line insertion technique using the landmark method (LM) to identify the target vein for catheter insertion does not account for potential anatomical variations at the insertion site. LM is associated with a high risk of mechanical complications. An x-ray exam is often required to confirm correct placement to minimize complications. Point-of-care ultrasound (POCUS) for central venous catheter (CVC) guidance has become a routine method in emergency medicine for identifying the vein location and providing real-time guidance for insertion. Chest x-ray represents the gold standard for verification of tip position after the catheter has been inserted. While using POCUS to guide CVC insertion removes the need for x-ray to confirm correct placement, an x-ray is still commonly ordered after CVC placement in the intensive care unit (ICU) and emergency department (ED) settings. As the use of POCUS-guided CVC insertion continues to expand in clinical practice, its clinical effectiveness compared with LM technique remains unclear. What Did We Do? To support decision-making, we conducted a rapid review to identify and summarize current studies and evidence-based guidelines that compared the clinical effectiveness of POCUS to landmark methods for CVC insertion. This report is an update to a previous report published in 2023. What Did We Find? Current evidence suggests that the use of POCUS to guide the insertion of CVC placement is effective compared with the landmark method. POCUS-guided CVC resulted in a significantly lower rate of complications for pneumo- or hemothorax, arterial puncture, and hematoma compared to LM when the internal jugular vein was targeted (0.9% versus 5.2%). Insertion at the femoral or subclavian veins resulted in variable findings. POCUS-guided central venous catheter insertion had a significantly higher correct placement rate compared to the conventional landmarking method (92% versus 75%). All 4 evidence-based guidelines provided recommendations for the use of POCUS-guided CVC insertion in emergency medicine, critical care, and acute care settings, although the strength of the recommendation varied depending on the targeted central vein. POCUS may offer advantages over x-ray when confirming CVC placement and screening for complications, although it may be less readily available than x-ray in some settings.

Project Status: Completed

URL for project: https://www.cda-amc.ca/point-care-ultrasound-guided-central-venous-catheter-insertion-compared-landmark-method

Year Published: 2025

URL for published report: https://www.cda-amc.ca/sites/default/files/pdf/htis/2025/RD0072-POCUS_for_CVC_Report.pdf

English language abstract: An English language summary is available

Publication Type: Rapid Review

Country: Canada

Organisation Name: Canada’s Drug Agency (CDA-AMC)

Contact Address: 865 Carling Ave., Suite 600 Ottawa, ON Canada K1S 5S8

Contact Name: Shannon Nordstrom

Contact Email: shannon.nordstrom@cda-amc.ca

Copyright: 2025 Canadian Agency for Drugs and Technologies in Health