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SYSTEMATIC REVIEW article

Front. Surg.
Sec. Pediatric Surgery
Volume 12 - 2025 | doi: 10.3389/fsurg.2025.1481975

Different Axis Approaches for Ultrasound-Guided Centrally Inserted Central Catheterization in Children: A Systematic Review and Meta-analysis of Randomized Controlled Trials

Provisionally accepted
In Kyung Lee In Kyung Lee 1Kyeong Hun Lee Kyeong Hun Lee 2Hye-Ji Han Hye-Ji Han 3Jieun Choi Jieun Choi 3Na Jin Kim Na Jin Kim 4Kyunghoon Kim Kyunghoon Kim 5*
  • 1 College of Medicine, Catholic University of Korea, Seoul, Republic of Korea
  • 2 Seoul St. Mary's Hospital, Seoul, Republic of Korea
  • 3 Seoul National University Bundang Hospital, Seongnam-si, Gyeonggi, Republic of Korea
  • 4 Catholic University of Korea, Seoul, Seoul, Republic of Korea
  • 5 College of Medicine, Seoul National University, Seoul, Seoul, Republic of Korea

The final, formatted version of the article will be published soon.

    Centrally inserted central catheterization (CICC) is a critical procedure in pediatric care.However, CVC in children poses greater challenges compared to adults due to anatomical and physiological differences, leading to higher complication rates. Ultrasound-guided approaches have been developed to enhance the safety and effectiveness of CICC, but the comparative efficacy of different axis approaches remains unclear.A systematic review and meta-analysis of randomized controlled trials comparing different axis approaches for ultrasound-guided CICC in children was conducted. Searches were carried out in databases up to June 10, 2024. Six studies were included in the systematic review and three studies were included in the meta-analysis. Primary outcomes included first-attempt success rate, overall success rate, and cannulation time. Secondary outcomes were complications such as hematoma and posterior wall puncture.Data from 547 children were analyzed. The long-axis in-plane approach significantly reduced cannulation time (MD -27.48 seconds, 95% CI, -33.99 to -20.97) and overall complications OR 0.21, 95% CI, 0.1 to 0.48) compared to short-axis out-of-plane approach. No significant differences were found in first-attempt or overall success rates between the long-axis and shortaxis approaches.The long-axis approach for ultrasound-guided CICC in children offers significant advantages in reducing cannulation time and complications. While dynamic needle tip positioning method may serve as an alternative to in-plane methods, further studies are needed to validate its clinical efficacy. Further research is needed to refine these techniques and explore their application in diverse clinical settings.

    Keywords: Central Venous Catheters, vascular access, Ultrasonography, Pediatrics, metaanalysis

    Received: 20 Aug 2024; Accepted: 10 Feb 2025.

    Copyright: © 2025 Lee, Lee, Han, Choi, Kim and Kim. This is an open-access article distributed under the terms of the Creative Commons Attribution License (CC BY). The use, distribution or reproduction in other forums is permitted, provided the original author(s) or licensor are credited and that the original publication in this journal is cited, in accordance with accepted academic practice. No use, distribution or reproduction is permitted which does not comply with these terms.

    * Correspondence: Kyunghoon Kim, College of Medicine, Seoul National University, Seoul, 03080, Seoul, Republic of Korea

    Disclaimer: All claims expressed in this article are solely those of the authors and do not necessarily represent those of their affiliated organizations, or those of the publisher, the editors and the reviewers. Any product that may be evaluated in this article or claim that may be made by its manufacturer is not guaranteed or endorsed by the publisher.