Utility of Ultrasound Guidance for Central Venous Access in Children.

BACKGROUND Placement of a central venous catheter (CVC) in a pediatric patient is an important skill for pediatric emergency medicine physicians but can be challenging and time consuming. Ultrasound (US) guidance has been shown to improve success of central line placement in adult patients. OBJECTIVES This article aims to review the literature and evaluate the benefit of US guidance in the placement of CVCs, specifically in pediatric emergency department patients, and to review the procedure. RESULTS Four meta-analyses of US-guided CVC placement in adult patients concluded that US guidance reduces placement failure, decreases complications, and decreases the need for multiple attempts. Two studies in the emergency department setting support these conclusions. Pediatric-specific data related to US-guided CVC placement include data suggesting a benefit with US guidance, as well as data indicating no difference in outcome measures when US guidance is used compared with the landmark technique. CONCLUSIONS The evidence surrounding US-guided CVC insertion supports its use in adult patients. Pediatric-specific literature is sparse and includes mixed results. As more pediatric emergency physicians adopt the use of point-of-care US, we expect an increase in data supporting its use for CVC placement in pediatric emergency department patients.