PURPOSE: Ultrasound-guidance is commonly used for the placement of central venous catheters (CVC). The Agency for Healthcare Research and Quality recommends the use of ultrasound for CVC placement as 1 of their 11 practices to improve patient care. Despite increased access to portable ultrasound machines and comfort with ultrasound-guided CVC access, fewer clinicians are familiar with ultrasound-guided techniques of arterial catheterization. The goal of this systematic review and meta-analysis was to determine the utility of real-time ultrasound-guidance for radial artery catheterization.
METHODS: A comprehensive literature search of Medline, Embase, the Cochrane Central Register of Controlled Trials, and conference proceedings by two independent reviewers identified randomized controlled trials comparing ultrasound-guidance with palpation techniques of radial artery catheterization. Data were extracted on study design, size, operator and patient characteristics, and the rate of first-attempt success. A meta-analysis was constructed to analyze the data.
RESULTS: Four trials with a total of 311 subjects were included in the review. 159 patients were catheterized using an ultrasound-guided technique, of which 43% had first-attempt success. 152 patients were catheterized using palpation techniques, of which 27% had first-attempt success. Compared with the palpation method, ultrasound-guidance was associated with a 71% improvement in the likelihood of first-attempt success (relative risk 1.71 95% confidence interval 1.25-2.32). Based on the absolute risk reduction of 16%, ultrasound guidance would be required for approximately six arterial catheter placements to prevent more than one attempt at insertion (NNT=6). The trials tended to show that the use of ultrasound-guidance resulted in a higher success rate, a reduced number of attempts, a reduced number of catheters used, and a faster time to catheterization. As the trials did not use uniform criteria to define these outcomes, they could not be combined formally in our meta-analysis.
CONCLUSION: Our meta-analysis demonstrated a 71% increase in the likelihood of first-attempt success when using ultrasound-guidance for radial artery catheterization.
CLINICAL IMPLICATIONS: Ultrasound-guidance is beneficial for radial artery catheterization. Further research is required to demonstrate cost effectiveness and reduction in complication rates.
DISCLOSURE: Ariel Shiloh, No Financial Disclosure Information; No Product/Research Disclosure Information