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. 2019 Aug 29;137(3):284–291. doi: 10.1590/1516-3180.2019.0113070519

Table 2. Characteristics of interventions, comparisons, participants and main findings and quality of evidence, as evaluated by means of grading of recommendations, assessment, development and evaluation (GRADE) .

Interventions Comparisons Participants Main findings GRADE
Real-time 2D ultrasound guidance12 Anatomical landmarks

  • Adults and children requiring venous hemodialysis catheter

  • Central venous catheter for non-dialysis indications and studies using audio Doppler ultrasound techniques were excluded

  • Favored ultrasound guidance:

  • ● reduction of 89% (overall) and 60% (first attempt) in the risk of catheter placement failure (7 studies, 830 catheters)

  • ● reduction of 87% in the risk of arterial puncture (6 studies, 535 catheters) and of 78% in the risk of hematomas (4 studies, 323 catheters)

  • ● reduction of time taken to achieve successful vein puncture (mean 1.4 minutes less)

 N.A.
Real-time 2D and Doppler ultrasound guidance13 Anatomical landmarks Adults and children requiring insertion of a central venous catheter via the internal jugular veins

  • Favored 2D ultrasound guidance:

  • ● reduction of 71% in the rate of total complications overall (14 trials, 2,406 participants)

  • ● reduction of the number of participants with an inadvertent arterial puncture by 72% (22 trials, 4,388 participants)

  • ● overall success rates increased by 12% (23 trials, 4,340 participants)

  • ● mean number of attempts until achieving success in the intervention groups was 1.19 lower (16 trials, 3,302 participants)

  • ● increase in the chance of success at the first attempt by 57% (18 trials, 2,681 participants)

  • ● reduction of the chance of hematoma formation by 73% (13 trials, 3,233 participants)

  • ● decrease in the time taken for successful cannulation by 30.52 seconds (20 trials, 3,451 participants)

  • Results for Doppler ultrasound techniques versus anatomical landmark were uncertain:

  • ● increase in the chance of success at the first attempt by 58% (four trials, 199 participants)

  • ● evidence of no difference regarding all other outcomes

 ● very low ● low ● very low ● very low ● moderate ● very low ● very low ● low ● very low to moderate
Real-time 2D and Doppler ultrasound guidance14 Anatomical landmarks Adults and children requiring insertion of a central venous catheter via the subclavian veins

  • Favored 2D ultrasound guidance:

  • ● decrease in arterial puncture by 79% (3 studies, 498 participants)

  • ● reduction of the chance of complications by 71% (6 trials, 1,058 participants)

  • Evidence of no difference regarding 2D and Doppler ultrasound guidance together:

  • ● total number of complications overall ranged from 77% lower to 17% higher (RR 0.52; 6 trials, 1,478 participants)

  • ● overall success rate ranged from 3% lower to 13% higher (RR 1.05; 8 trials, 1,809 participants)

  • Evidence of no difference regarding 2D ultrasound guidance:

  • ● number of attempts until achieving success in the intervention groups ranged from 1.26 lower to 0.5 higher (mean 0.38 lower; 2 trials, 471 participants)

  • ● time taken to achieve successful cannulation in the intervention groups ranged from 56.92 seconds lower to 77.87 seconds higher (mean 10.48 seconds higher; 2 trials, 471 participants)

  • ● success at first attempt ranged from reduction by 15% to increase by 36% (RR 1.08; 2 studies, 115 participants)

  • ● low

  • ● very low

  • ● very low

  • ● low

  • ● very low

  • ● low

  • ● high
Real-time 2D and Doppler ultrasound guidance14 Anatomical landmarks Adults and children requiring insertion of a central venous catheter via the femoral veins

  • Favored 2D ultrasound guidance:

  • ● increase in overall success rates ranged from none to 23% higher (RR 1.11, 4 studies, 311 participants)

  • ● increased success at first attempt in 73% (3 studies, 224 participants)

  • Evidence of no difference regarding 2D ultrasound guidance:

  • ● risk of arterial puncture ranged from 86% lower to 16% higher (RR 0.4; 4 studies, 311 participants)

  • ● complications rate ranged from 89% lower to 212% higher (RR 0.49; 4 trials, 311 participants)

  • No data available regarding Doppler ultrasound guidance

  • ● moderate

  • ● high

  • ● low

  • ● low

  • N.A.
Real-time 2D ultrasound guidance15 Other techniques (palpation/ Doppler ultrasound) Children (one month to 18 years of age) undergoing arterial line placement

  • Favored 2D ultrasound guidance:

  • ● increase in first-attempt catheter placement success in 96% (4 studies, 404 participants)

  • ● reduction of the chance of complications (hematoma or ischemia) by 80% (2 studies, 222 participants)

  • ● increase in successful cannulation within the first two attempts in 78% (2 studies, 134 participants)

  • ● moderate

  • ● moderate

  • ● moderate

N.A. = not available; 2D = two-dimensional; RR = relative risk.