Point-of-Care Ultrasound for Guided Central Venous Catheter Insertion Compared to the Landmark Method

Key Messages

What Is the Issue?

• Conventional central line insertion technique using the landmark method to identify the target vein for catheter insertion does not account for potential anatomical variations at the insertion site.
• The landmark method is associated with a high risk of mechanical complications. An X-ray exam is often required to confirm correct placement to minimize complications.
• Point-of-care ultrasound (POCUS) for central venous catheter (CVC) guidance has become a routine method in emergency medicine for identifying the vein location and providing real-time guidance for insertion.
• A chest X-ray represents the gold standard for verifying the position of the catheter tip after it has been inserted. Although using POCUS to guide CVC insertion removes the need for an X-ray to confirm its correct placement, an X-ray is still commonly ordered after CVC placement in the intensive care unit (ICU) and emergency department settings.
• The use of POCUS-guided CVC insertion continues to expand in clinical practice, yet its clinical effectiveness compared with the landmark method remains unclear.

What Did We Do?

• To support decision-making, we conducted a rapid review to identify and summarize current studies and evidence-based guidelines that compared the clinical effectiveness of POCUS to the landmark method for CVC insertion. This report is an update to a previous report published in 2023.¹

What Did We Find?

• Current evidence suggests that the use of POCUS to guide CVC placement is effective compared with the landmark method.
• POCUS-guided CVC resulted in a significantly lower rate of complications for pneumo- or hemothorax, arterial puncture, and hematoma compared to the landmark method when the internal jugular vein was targeted (0.9% versus 5.2%). Insertion at the femoral or subclavian veins resulted in variable findings.
• POCUS-guided CVC insertion had a significantly higher correct placement rate compared to the conventional landmarking method (92% versus 75%).
• All 4 evidence-based guidelines provided recommendations for the use of POCUS-guided CVC insertion in emergency medicine, critical care, and acute care settings, although the strength of the recommendations varied depending on the targeted central vein.
• POCUS may offer advantages over X-ray when confirming CVC placement and screening for complications, although it may be less readily available than X-ray in some settings.