The following is a summary of “Ultrasound-guided central venous catheterization around the neck: Systematic review and network meta-analysis,” published in the April 2024 issue of Emergency Medicine by Imai, et al.

Central venous catheterization (CVC) guided by ultrasound is now the norm. Still, clinicians employ various methods, including the internal jugular vein (IJV), supraclavicular subclavian vein (SupraSCV), infraclavicular subclavian vein (InfraSCV), proximal axillary vein (ProxiAV), distal axillary vein (DistalAV), and femoral vein. For a study, researchers sought to compare the first-pass success rate and arterial puncture rate for different ultrasound-guided CVC approaches above the diaphragm.

In May 2023, a comprehensive search was conducted in Embase, MEDLINE, CENTRAL, ClinicalTrials.gov, and the World Health Organization International Clinical Trials Platform for randomized controlled trials (RCTs) comparing the five CVC approaches. The Confidence in Network Meta-Analysis tool was employed to evaluate confidence. About 13 RCTs (comprising 4,418 participants and 13 comparisons) were included in the analysis.

The SupraSCV approach likely increases first-attempt success compared to the other four approaches, with risk ratios (RRs) > 1.21 and lower 95% CIs exceeding 1. In comparison to the IJV, the SupraSCV approach likely enhanced first-attempt success (RR 1.22; 95% CI 1.06–1.40, moderate confidence), while the DistalAV approach reduced it (RR 0.72; 95% CI 0.59–0.87, high confidence). There was little to no difference in arterial puncture rates across all approaches (low to high confidence).

Regarding first-attempt success and mechanical complications, the SupraSCV approach may emerge as the preferred method, while the DistalAV approach could be considered less preferable. Nevertheless, further head-to-head studies comparing approaches with the highest first-attempt success rates are warranted.

Reference: sciencedirect.com/science/article/abs/pii/S0735675724000585