Ultrasound Guidance Superior to Landmark Technique for Pediatric Central Line Placement

Authors: Gallagher RA et al., Acad Emerg Med 2014 Sep 21:981

Ultrasound guidance resulted in a higher success rate, with similar rates of complications.

Ultrasound-guided central line placement has shown mixed results in the pediatric population. These investigators retrospectively evaluated success and complication rates of central line placement by pediatric emergency physicians with and without ultrasound guidance at a single pediatric emergency department over 8 years. The landmark technique was used for the first 3 years, ultrasound was used intermittently for the next 3 years, and, after a formal ultrasound training program was instituted, ultrasound guidance was used exclusively for the last 2 years.

During the study period, 131 femoral and 37 internal jugular lines were placed in 168 patients (median age, 11 years), with a median of 17 central lines placed annually. All 70 lines placed with the landmark technique were femoral; of 98 lines placed with ultrasound guidance, 62% were femoral and 38% were jugular. Ultrasound guidance was superior to the landmark technique in rate of successful placement (98% vs. 79%). Complication rates were similar between groups (17% and 19%). Arterial puncture was the most common complication, followed by attempts at multiple sites; no patient incurred a pneumothorax or hemothorax.

Comment
Visualizing targeted vascular structures improves success. This study provides compelling evidence that ultrasound guidance for pediatric central venous catheter placement should be mandated, particularly for providers who perform these procedures infrequently.