title: NICE guidelines for central venous catheterization in children. Is the evidence base sufficient?
abstract: BACKGROUND
  Recent guidelines from the National Institute for Clinical Excellence (NICE) recommend the use of ultrasound guidance for central venous catheterization in children. This study prospectively examined the use of ultrasound guidance for central venous catheterization in children undergoing heart surgery.
  
  
  METHODS
  One hundred and twenty-four infants and children were randomized to either ultrasound-guided or traditional landmark-guided central venous catheterization.
  
  
  RESULTS
  Success rates were significantly greater in the landmark group compared with the ultrasound group (89.3% vs 78%, P<0.002), and arterial puncture rates were significantly lower in the landmark group (6.2% vs 11.9%, P<0.03). There was no significant difference between the two groups in the time taken to perform the catheterization.
  
  
  CONCLUSIONS
  These results are different from the published results on which the NICE guidelines were based; however, the evidence base in children is small. There is currently insufficient evidence to support the use of ultrasound guidance for central venous catheterization in children.
authors.affiliation: Nuffield Department of Anaesthetics, John Radcliffe Hospital, Oxford OX3 9DU, UK. kategreb@btinternet.com
authors.forename: C R
authors.initials: CR
authors.lastname: Grebenik
authors.forename: A
authors.initials: A
authors.lastname: Boyce
authors.forename: M E
authors.initials: ME
authors.lastname: Sinclair
authors.forename: R D
authors.initials: RD
authors.lastname: Evans
authors.forename: D G
authors.initials: DG
authors.lastname: Mason
authors.forename: B
authors.initials: B
authors.lastname: Martin
mesh_terms: D020212:Carotid Artery Injuries / Q000209:etiology / Q000517:prevention & control; D002405:Catheterization, Central Venous / Q000009:adverse effects / Q000379:methods*; D002648:Child; D002675:Child, Preschool; D019317:Evidence-Based Medicine; D006801:Humans; D007223:Infant; D007231:Infant, Newborn; D007601:Jugular Veins / Q000000981:diagnostic imaging; D017410:Practice Guidelines as Topic; D011446:Prospective Studies; D018084:Ultrasonography, Interventional