Ultrasound guidance improves arterial cannulation success and reduces hematoma risk in children
Cochrane Pre-hospital and Emergency Care
Ultrasound guidance improves arterial cannulation success and reduces hematoma risk in children.
SOURCE
Raphael CK, El Hage Chehade NA, Khabsa J, Akl EA, Aouad-Maroun M, Kaddoum R.
Ultrasound-guided arterial cannulation in the paediatric population.
Cochrane Database of Systematic Reviews 2023, Issue 3. Art. No.: CD011364.
DOI: 10.1002/14651858.CD011364.pub3.
CONTEXT
The anatomy and the smaller size of pediatric patients can make arterial line cannulation more difficult than in adults. For both radial and femoral sites, ultrasound guidance may increase success rates and improve the safety of arterial cannulation compared to palpation or Doppler auditory assistance.
CLINICAL QUESTIONS
Is ultrasound guidance better than palpation or Doppler auditory assistance in pediatric arterial line cannulation?
BOTTOM LINE
Compared with palpation or Doppler assistance, ultrasound-guided arterial line cannulation in the pediatric population probably increases first-attempt success rate, success within the first two attempts and overall successful cannulation (moderate level of evidence). It probably decreases both the number of cannulation attempts as well as the duration of the procedure (moderate level of evidence). It also probably decreases hematoma formation (moderate level of evidence).
CAVEATS
Performance bias was present in all studies, as medical providers could not be blinded to the guidance technique. Some studies did not describe allocation concealment leading to potential selection bias. Finally, studies did not specify if the primary outcome - first pass successful arterial cannulation - included redirection of the needle.
AUTHORS
Michael Schaulin
michael.schaulin.med@ssss.gouv.qc.ca
Centre Hospitalier Affilié Universitaire Régional (CHAUR), Trois-Rivières (Québec),
Canada
Chady El Tawil
chady.eltawil.med@ssss.gouv.qc.ca
Centre Hospitalier Affilié Universitaire Régional (CHAUR), Trois-Rivières (Québec),
Canada
Montreal Children’s Hospital, Montreal (Québec), Canada
