title: Use of real-time ultrasound guidance for the placement of hemodialysis catheters: a systematic review and meta-analysis of randomized controlled trials.
abstract: BACKGROUND
  Insertion of percutaneous hemodialysis catheters is an invasive procedure with a small but definite risk of morbidity and mortality.
  
  
  OBJECTIVE
  Assessing potential benefits of using real-time 2-dimensional Doppler ultrasound imaging guidance for the insertion of hemodialysis catheters compared with insertion based solely on anatomic landmarks.
  
  
  METHODS
  Systematic review and meta-analysis of randomized controlled trials.
  
  
  METHODS
  MEDLINE (1966 to July 2010), EMBASE (1980 to July 2010), Cochrane Renal Group Specialised Register, and Cochrane Central Register of Controlled Trials (CENTRAL).
  
  
  METHODS
  Patients requiring hemodialysis catheter insertion.
  
  
  METHODS
  We included all randomized controlled trials regardless of publication status or language.
  
  
  METHODS
  Real-time 2-dimensional Doppler ultrasound image guidance.
  
  
  RESULTS
  Catheter placement failures, catheters failed to be placed in the first attempt, attempts per catheter inserted, time taken for successful venous puncture, and complications (carotid artery puncture, pneumo- or hemothorax, neck hematoma, and brachial plexus injury). Treatment effects were summarized with the RR measure for dichotomous outcomes and mean difference for continuous outcomes.
  
  
  RESULTS
  7 trials with 830 catheters were identified. Ultrasound guidance significantly decreased the risk of the following outcomes: catheter placement failure (7 studies, 830 catheters; RR, 0.12; 95% CI, 0.04-0.37), failure to place catheter on first attempt (5 studies, 595 catheters; RR, 0.40; 95% CI, 0.29-0.56), arterial punctures (6 trials, 785 catheters; RR, 0.22; 95% CI, 0.06-0.81), and hematoma formation (4 trials, 323 catheters; RR, 0.27; 95% CI, 0.08-0.88). It also significantly decreased the time to cannulate the vein (1 trial, 73 catheters; mean difference, -1.40; 95% CI, -2.17 to -0.63), and number of attempts per catheter insertion (1 trial, 110 catheters; mean difference, -0.35; 95% CI, -0.54 to -0.16).
  
  
  CONCLUSIONS
  Only 7 studies were identified, of which 3 were reported in only a conference abstract form. Some outcomes were reported in only 1 study.
  
  
  CONCLUSIONS
  Use of real-time Doppler ultrasound guidance has benefits with respect to several important clinical outcomes, and its routine use in the insertion of hemodialysis catheters is strongly recommended.
authors.affiliation: Renal Unit, New Cross Hospital, Wolverhampton, United Kingdom. ksrabi@yahoo.co.uk
authors.forename: Kannaiyan Samuel
authors.initials: KS
authors.lastname: Rabindranath
authors.forename: Emil
authors.initials: E
authors.lastname: Kumar
authors.forename: Ranjit
authors.initials: R
authors.lastname: Shail
authors.forename: Emma
authors.initials: E
authors.lastname: Vaux
mesh_terms: D002405:Catheterization, Central Venous / Q000379:methods*; D003199:Computer Systems; D006801:Humans; D016032:Randomized Controlled Trials as Topic; D006435:Renal Dialysis; D025321:Surgery, Computer-Assisted; D018608:Ultrasonography, Doppler