Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
Meta-Analysis
. 2024 Nov 19;28(1):378.
doi: 10.1186/s13054-024-05162-0.

Central venous catheter-related infections: a systematic review, meta-analysis, trial sequential analysis and meta-regression comparing ultrasound guidance and landmark technique for insertion

Nicolas Boulet  1 , Joris Pensier  2 , Bob-Valéry Occean  3 , Pascale Fabbro Peray  3 , Olivier Mimoz  4 , Claire M Rickard  5 , Niccolò Buetti  6   7 , Jean-Yves Lefrant  8 , Laurent Muller  8 , Claire Roger  8
Affiliations
Meta-Analysis

Central venous catheter-related infections: a systematic review, meta-analysis, trial sequential analysis and meta-regression comparing ultrasound guidance and landmark technique for insertion

Nicolas Boulet et al. Crit Care. .

Abstract

Background: During central venous catheterization (CVC), ultrasound (US) guidance has been shown to reduce mechanical complications and increase success rates compared to the anatomical landmark (AL) technique. However, the impact of US guidance on catheter-related infections remains controversial. This systematic review and meta-analysis aimed to compare the risk of catheter-related infection with US-guided CVC versus AL technique.

Methods: A systematic search on MEDLINE, Cochrane Central Register of Controlled Trials (CENTRAL), and Web of Science databases was conducted until July 31, 2024. Randomized controlled trials (RCTs) and non-randomized studies of intervention (NRSI) comparing US-guided versus AL-guided CVC placement were included. The primary outcome was a composite outcome including all types of catheter-related infection: catheter-related bloodstream infections (CRBSIs), central line-associated bloodstream infections (CLABSIs), catheter colonization, or any other type of reported infection. The secondary outcomes included individual infection types and mortality at day-28. Subgroup analyses based on study type and operator experience were also performed.

Results: Pooling twelve studies (8 RCTs and 4 NRSI), with a total of 5,092 CVC procedures (2072 US-guided and 3020 AL-guided), US-guided CVC was associated with a significant reduction in catheter-related infections compared with the AL technique (risk ratio (RR) = 0.68, 95% confidence interval (CI) 0.53-0.88). In the RCT subgroup, the pooled RR was 0.65 (95% CI 0.49-0.87). This effect was more pronounced in procedures performed by experienced operators (RR = 0.60, 95% CI 0.41-0.89). In inexperienced operators, the infection risk reduction was not statistically significant. The pooled analysis of CRBSIs and CLABSIs also favored US guidance (RR = 0.65, 95% CI 0.48-0.87).

Conclusion: US-guided CVC placement significantly reduces the risk of catheter-related infections compared to the AL technique, particularly when performed by experienced operators. Trial registration PROSPERO CRD42022350884. Registered 13 August 2022.

Keywords: Catheter-related bloodstream infection; Central venous catheterization; Meta-analysis; Ultrasound guidance.

PubMed Disclaimer

Conflict of interest statement

Declarations Ethics approval and consent to participate Not relevant. Consent for publication Not relevant. Competing interests The authors declare no competing interests.

Figures

Fig. 1
Fig. 1
Flow chart of the study NRSI non-randomized studies of intervention, RCTs randomized controlled studies
Fig. 2
Fig. 2
Assessment of risk of bias. A Randomized controlled trials. B Non-Randomized Studies of Intervention
Fig. 3
Fig. 3
A Forest plot comparing the incidence of central venous catheter infections (composite outcome) between ultrasound-guided versus anatomical landmark technique. B Trial Sequential Analysis
Fig. 4
Fig. 4
Forest plot comparing the incidence of central venous catheter infections (composite outcome) between ultrasound-guided versus anatomical landmark technique, according to the operators’ experience
See this image and copyright information in PMC

References

    1. Timsit J, Baleine J, Bernard L, Calvino-Gunther S, Darmon M, Dellamonica J, et al. Expert consensus-based clinical practice guidelines management of intravascular catheters in the intensive care unit. Ann Intensive Care. 2020. 10.1186/s13613-020-00713-4. - PMC - PubMed
    1. Boulet N, Muller L, Rickard CM, Lefrant JY, Roger C. How to improve the efficiency and the safety of real-time ultrasound-guided central venous catheterization in 2023: a narrative review. Ann Intensive Care. 2023;13(1):46. - PMC - PubMed
    1. Wu S, Ling Q, Cao L, Wang J, Xu M, Zeng W. Real-time Two-dimensional Ultrasound Guidance for Central Venous Cannulation: A Meta-analysis. Anesthesiology. 2013;118(2):361–75. - PubMed
    1. Brass P, Hellmich M, Kolodziej L, Schick G, Smith AF. Ultrasound guidance versus anatomical landmarks for internal jugular vein catheterization. Cochrane Database Syst Rev. 2015;1:CD006962. - PMC - PubMed
    1. Brass P, Hellmich M, Kolodziej L, Schick G, Smith AF. Ultrasound guidance versus anatomical landmarks for subclavian or femoral vein catheterization. Cochrane Database Syst Rev. 2015;1:CD011447. - PMC - PubMed

MeSH terms