Ultrasound-Guided Central Venous Catheterization in Intensive Care

Abstract

Introduction: Real-time ultrasound guidance for central venous catheter (CVC) placement reduces mechanical complications, but adoption varies. This review compares outcomes of ultrasound versus landmark technique in ICU patients.
Methods: Systematic literature search (2010–2024) for RCTs and meta-analyses comparing dynamic ultrasound guidance to landmark or Doppler methods for internal jugular, subclavian, and femoral CVC insertion in adults. Primary outcomes: first-pass success, arterial puncture, and hemothorax.
Results: Twenty-two RCTs (n=6,308) showed ultrasound increased first-pass success (OR 2.4, 95% CI 1.9–3.0), reduced arterial puncture (OR 0.31), and decreased hemothorax (OR 0.20) compared to landmark. Subclavian vein cannulation benefited most from ultrasound. Time to cannulation was similar.
Discussion: Ultrasound visualizes vessel anatomy and variations, preventing mispunctures. Two-dimensional real-time guidance is superior to static marking. Training and equipment access remain barriers.
Conclusions: Real-time ultrasound guidance is the standard of care for elective CVC insertion in ICU, improving safety and efficiency. Mandatory training programs should be implemented.