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Ultrasound-Guided Catheterization of the Femoral Artery: A Systematic Review and Meta-analysis of Randomized Controlled Trials FREE TO VIEW

Maria Sobolev; Alfredo Lee Chang; Ariel Shiloh; Lewis Eisen
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Montefiore Medical Center/Albert Einstein College of Medicine, Bronx, NY

Chest. 2014;146(4_MeetingAbstracts):236A. doi:10.1378/chest.1991181
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SESSION TITLE: Sepsis & Septic Shock Posters

SESSION TYPE: Original Investigation Poster

PRESENTED ON: Wednesday, October 29, 2014 at 01:30 PM - 02:30 PM

PURPOSE: Ultrasound-guidance is routinely used for the placement of central venous catheters. The Agency for Healthcare Research and Quality recommends ultrasound-guidance for central venous catheter placement to prevent complications. Despite increased access to portable ultrasound machines, fewer clinicians are familiar with ultrasound-guided arterial catheterization. A recent meta-analysis demonstrated that ultrasound-guidance for radial artery catheterization improves first-pass success rate. The goal of this meta-analysis was to determine the utility of real-time two-dimensional (2-D) ultrasound-guidance for femoral artery catheterization.

METHODS: A comprehensive literature search of Medline, Embase, Google Scholar, the Cochrane Central Register of Controlled Trials by two independent reviewers identified prospective, randomized controlled trials comparing ultrasound-guidance with traditional palpation techniques of femoral artery catheterization (with or without fluoroscopy). Additionally, five years of conference abstracts from critical care, interventional radiology, and cardiology were reviewed. Data were extracted on study design, study size, operator and patient characteristics, the rate of first-pass success, number of attempts, and complications. A meta-analysis was constructed to analyze the data (Review Manager, RevMan 5.2. Copenhagen, The Cochrane Collaboration, 2012).

RESULTS: Four trials with a total of 1,422 subjects were included in the review, with 703 subjects included in the palpation group and 719 subjects in the ultrasound-guided group. There was a 51% reduction in overall complications (relative risk 0.51 [95% confidence interval 0.28 - 0.91]), including hematoma and accidental venipuncture, in the ultrasound-guided group. Ultrasound-guidance was associated with a 42% improvement in the likelihood of first-pass success (relative risk 1.42 [95% confidence interval 1.01-2.00]). There was decreased time to arterial access with ultrasound-guidance (mean difference -25.60 seconds [95% confidence interval -38.11 - -13.09]), as well as a decreased number of attempts which was not statistically significant (mean difference -0.75 [95% confidence interval -1.78 - 0.28]).

CONCLUSIONS: The use of real-time 2-D ultrasound-guidance for femoral artery catheterization decreases complication rates, improves first-pass success rate, and decreases time to access.

CLINICAL IMPLICATIONS: Similar to central venous access, ultrasound-guidance is recommended for femoral arterial catheterization.

DISCLOSURE: The following authors have nothing to disclose: Maria Sobolev, Alfredo Lee Chang, Ariel Shiloh, Lewis Eisen

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