Skip to main content

Comparison of ultrasound-guided modified Seldinger technique versus blind puncture for peripherally inserted central catheter: a meta-analysis of randomized controlled trials

The peripherally inserted central catheter (PICC) has been used for central venous pressure monitoring and building effective infusion routes in a critical care setting. The traditional blind puncture technique for PICC has been challenging. The ultrasound-guided modified Seldinger technique (MST) has been used as an adjunct for central venous catheter and has shown significant benefits over the traditional blind puncture. However, despite clear advantages, complications of ultrasound-guided MST for PICC still occur. We conducted a meta-analysis of randomized controlled trials (RCTs) to compare the ultrasound-guided MST and traditional blind puncture techniques for PICC.

PubMed and CNKI (Chinese database) were searched for RCTs comparing the ultrasound-guided MST and traditional palpation for radial artery catheterization. Differences were expressed as relative risks (RRs) with 95% confidence intervals (CIs) for dichotomous outcomes. The fixed-effects model or random-effects model was used, depending on whether heterogeneity existed among studies. Heterogeneity among studies was examined with Cochran’s Q statistic (P < 0.1) and the I2 statistic. A two-tailed P value of less than 0.05 was considered a significant level except for where a certain P value has been given. Six RCTs enrolling 726 patients (367 trials and 359 controls) were included in the meta-analysis [1-6]. Three studies [1,3,4] report that the first-attempt success rate of ultrasound-guided MST was superior to that of the traditional blind puncture, and three studies [2,5,6] report that the first-attempt success rate was similar for the two techniques. The meta-analysis indicated that ultrasound-guided MST was not significantly associated with improvement in first-attempt success (RR = 1.07, 95% CI 0.99 to 1.16, P = 0.090) compared with the traditional blind puncture, but ultrasound-guided MST significantly reduced the incidence of complication after surgery (RR = 0.24, 95% CI 0.08 to 0.76, P = 0.015).

In summary, ultrasound-guided MST is superior to the traditional blind puncture technique for PICC, especially for postoperative complications. It should be generalized to clinical application for PICC.

Abbreviations

CI:

Confidence interval

MST:

Modified Seldinger technique

PICC:

Peripherally inserted central catheter

RCT:

Randomized controlled trial

RR:

Relative risk

References

  1. Knebel P, Fischer L, Huesing J, Hennes R, Buchler MW, Seiler CM. Randomized clinical trial of a modified Seldinger technique for open central venous cannulation for implantable access devices. Br J Surg. 2009; 96:159–65.

    CAS  Article  Google Scholar 

  2. Wan YH, Tan F, Chen Q, Wang Q. Effects of modified Seldinger technique in vascular ultrasound-guided PICC placement of upper arm. Nurs J Chin PLA. 2010; 27:1507–8.

    Google Scholar 

  3. Bao AQ, Wen Q, Liu WH. Using ultrasound-guided modified Seldinger technique for PICC insertion. J Nurs Sci. 2010;25:57–8.

    Google Scholar 

  4. Ding RM, Yang Y, Wang P, Ma LJ. Ultrasound-guided modified Seldinger technique PICC and conventional PICC in the study of difficult comparison tube. Chin J Med Guid. 2013;15:2106–2108.

    Google Scholar 

  5. Li J, Fan YY, Xin MZ, Yan J, Hu W, Huang WH. A randomised, controlled trial comparing the long-term effects of peripherally inserted central catheter placement in chemotherapy patients using B-mode ultrasound with modified Seldinger technique versus blind puncture. Eur J Oncol Nurs. 2014;18:94–103.

    Article  Google Scholar 

  6. Liu ZM, Liu CY, Shi SQ, Zhang J. Clinical study of the comparison of ultrasound-guided modified Seldinger technique and blind wear of placement of PICC. J Nurs Train. 2012; 27:773–5.

    Google Scholar 

Download references

Acknowledgments

This work was supported by a Hunan Province Science and Technology Project (2014SK2013) and fundamental research funds for the central universities of Central South University (2014zzts069).

Author information

Authors and Affiliations

Authors

Corresponding author

Correspondence to LiZhang Chen.

Additional information

Competing interests

The authors declare that they have no competing interests.

Authors’ contributions

ZZL and LZC conceived the study, participated in the design, collected the data, and drafted the manuscript. Both authors read and approved the final manuscript.

Rights and permissions

This article is licensed under a Creative Commons Attribution 4.0 International License, which permits use, sharing, adaptation, distribution and reproduction in any medium or format, as long as you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons licence, and indicate if changes were made. The images or other third party material in this article are included in the article's Creative Commons licence, unless indicated otherwise in a credit line to the material. If material is not included in the article's Creative Commons licence and your intended use is not permitted by statutory regulation or exceeds the permitted use, you will need to obtain permission directly from the copyright holder. To view a copy of this licence, visit http://creativecommons.org/licenses/by/4.0/. The Creative Commons Public Domain Dedication waiver (http://creativecommons.org/publicdomain/zero/1.0/) applies to the data made available in this article, unless otherwise stated in a credit line to the data.

Reprints and Permissions

About this article

Verify currency and authenticity via CrossMark

Cite this article

Li, Z., Chen, L. Comparison of ultrasound-guided modified Seldinger technique versus blind puncture for peripherally inserted central catheter: a meta-analysis of randomized controlled trials. Crit Care 19, 64 (2015). https://doi.org/10.1186/s13054-015-0742-y

Download citation

  • Published:

  • DOI: https://doi.org/10.1186/s13054-015-0742-y

Keywords

  • Central Venous Catheter
  • Central Venous Pressure
  • Radial Artery
  • Dichotomous Outcome
  • Central Catheter