US Guidance Improves Safety and Efficiency of Central Line Placement

Infographic · Sep 2019 · 1 min read

In brief

Retrospective study of 2,010 pediatric tunneled central lines demonstrates that transitioning from landmark-based to ultrasound-guided placement eliminated chest tube insertions (9.7/1000 to 0/1000) and reduced operative time by 11 minutes. Complete practice transition was achieved within two years, establishing ultrasound guidance as safer and more efficient for pediatric central venous access.

Ultrasound-guided central line placement eliminated chest tube complications (0/1000) vs landmark approach (9.7/1000 procedures, p=0.009)
OR time decreased significantly with ultrasound guidance: 46 min vs 57 min with landmark technique (p<0.001)
Complete practice transition from landmark to ultrasound-guided technique was achievable within 2 years in pediatric surgery
Study of 2,010 pediatric tunneled central lines represents largest analysis of ultrasound-guided venous access in children
Ultrasound guidance should be standard of care for pediatric central venous access, mirroring adult practice guidelines

Written by the GCMD Library team from the infographic.

A three-column comparison layout with dark blue and teal backgrounds. The left column shows study parameters with icons (chest X-ray and clock). The middle columns display anatomical torso illustration and numerical outcomes. The right column, highlighted with white border, shows ultrasound equipment icon and improved metrics with downward arrows indicating reduction.

Use of ultrasound-guidance for central venous access in adults is the standard of care. There is, however, less clarity in the role of routine ultrasound use in obtaining venous access in children. We sought to evaluate safety and efficiency of the placement of central lines utilizing an ultrasound-guided approach compared to the traditional, landmark approach in pediatric patients.

Study design

A single-institution retrospective chart review, using CPT codes, was performed for all tunneled central venous catheters in children between 2005 and 2017 by the same pediatric surgery group. During the study period, a practice change occurred from exclusively landmark-based line placement to ultrasound-guided line placement. Groups were divided into three phases: a traditional/landmark era (Phase 1), transitional period (Phase 2), and the ultrasound era (Phase 3). The primary outcomes analyzed were postoperative chest tube insertions and operative time.

Results

A total of 2010 tunneled central lines were included for analysis: Phase 1 (N = 930), Phase 2 (N = 313) and Phase 3 (N = 767). Venous access for chemotherapy was the most common indication (29%). Phase 1 had a chest tube placement rate of 9.7/1000 procedures, while Phase 2 had a rate of 6.4/1000 procedures, and Phase 3 had no chest tube insertions (p = 0.009). Phase 1 had longer OR times compared to Phase 2 (57 vs. 49, p = 0.0026) and Phase 3 (57 vs. 46 min, p < 0.001).

Conclusions

This study represents the largest analysis of ultrasound-guided access for children. A complete practice transition to the ultrasound-guided approach was feasible within a two-year period. The ultrasound-guided approach had a shorter operative time and less chest tube insertions than the traditional, landmark technique in children.

Level III

Visual abstract created by Alejandra M Casar Berazaluce, MD - Pediatric Surgery Research Fellow at Cincinnati Children's Hospital Medical Center.

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