Comparison of Ultrasound Guided and Conventional Techniques for Peripheral Venous Catheter Insertion in Pediatric Patients: A Systematic Review and Meta-Analysis of Randomized Controlled Trials

BACKGROUND: Ultrasound guided cannulation for peripheral venous insertion is a well-established methodology. However, there has never been a systematic review completed to synthesize evidence within the pediatric population. The current systematic review and meta-analysis was completed to compare the efficacy and safety profile of ultrasound guided peripheral cannulation against the conventional palpation technique within pediatric patients. METHODS: A comprehensive search was conducted within the digital databases including Medline, EMBASE, ScienceDirect, Google Scholar and Cochrane library from inception until August 2021. A meta-analysis was then completed with random-effects model and reported pooled risk ratio (RR) or standardized mean difference (SMD) with 95% confidence interval (CI). RESULTS: In total, 9 studies were analyzed, which included 1,312 participants, and the majority of studies (5 out 9 studies) were considered high quality. Amongst efficacy outcomes, first attempt success rate had a pooled RR of 1.53 (95% CI: 1.14–2.04), overall success rate had a pooled RR of 1.13 (95% CI: 1.01–1.26), number of attempts before successful cannulation had a pooled SMD of −1.93 [95%CI: −3.44 to −0.42], time taken for successful cannulation had a pooled SMD of −0.46 [95%CI: −1.20 to 0.28], needle redirections before successful cannulation had a pooled SMD of −1.26 [95%CI: −2.47 to −0.06]. Amongst safety outcomes, venous extravasation had a pooled RR of 1.59 (95% CI: 0.99–2.54) and phlebitis had an RR of 0.31 (95% CI: 0.07–1.50). CONCLUSION: Within pediatric patients, ultrasound guided peripheral venous cannulation is more efficacious when compared to the conventional palpation technique. Systematic Review Registration: https://www.crd.york.ac.uk/prospero/display_record.php?ID=CRD42021275305, identifier: CRD42021275305.