title: Ultrasound guidance for placement of central venous catheters: a meta-analysis of the literature.
abstract: OBJECTIVE
  To evaluate the effect of real-time ultrasound guidance using a regular or Doppler ultrasound technique for placement of central venous catheters.
  
  
  METHODS
  We searched for published and unpublished research using MEDLINE, citation review of relevant primary and review articles, conference abstracts, personal files, and contact with expert informants.
  
  
  METHODS
  From a pool of 208 randomized, controlled trials of venous and arterial catheter management, eight published randomized, controlled trials were identified.
  
  
  METHODS
  In duplicate, independently, we abstracted data on the population, intervention, outcome, and methodologic quality.
  
  
  RESULTS
  Ultrasound guidance significantly decreases internal jugular and subclavian catheter placement failure (relative risk 0.32; 95% confidence interval 0.18 to 0.55), decreases complications during catheter placement (relative risk 0.22; 95% confidence interval 0.10 to 0.45), and decreases the need for multiple catheter placement attempts (relative risk 0.60; 95% confidence interval 0.45 to 0.79) when compared with the standard landmark placement technique.
  
  
  CONCLUSIONS
  When used for vessel location and catheter placement real-time, ultrasound guidance or Doppler ultrasound guidance improves success rates and decreases the complications associated with internal jugular and subclavian venous catheter placement.
authors.affiliation: Division of Pediatric Critical Care, Primary Children's Medical Center, Salt Lake City, UT, USA.
authors.forename: A G
authors.initials: AG
authors.lastname: Randolph
authors.forename: D J
authors.initials: DJ
authors.lastname: Cook
authors.forename: C A
authors.initials: CA
authors.lastname: Gonzales
authors.forename: C G
authors.initials: CG
authors.lastname: Pribble
mesh_terms: D002405:Catheterization, Central Venous / Q000379:methods*; D006801:Humans; D016032:Randomized Controlled Trials as Topic; D018608:Ultrasonography, Doppler