Objective: To examine the burden of insertion-related outcomes and the effect of ultrasound-guided insertion of non-tunneled central venous catheters (CVCs).

Methods: A systematic literature review was undertaken in PubMed to (1) identify studies reporting insertion-related outcomes regardless of imaging use, and (2) comparative studies of image-guided insertion or detection of complications within non-tunneled CVCs use. Insertion-related outcomes include insertion failure/success, procedural difficulty, number of attempts, and malposition/satisfactory positioning. The search included all English, full-text articles published within 10 years of August 12, 2021. Studies evaluating CVCs in pediatric-specific patient populations were excluded, as were those only reporting results for tunneled CVC, peripherally inserted central catheters (PICCs), or ports. Study characteristics such as methodology, setting, data source(s), time horizon, patient population, imaging use, CVC type(s), CVC insertion location(s), and the number of patients/catheters were extracted in addition to the results.

Results: After screening, there were 14 full-text articles included in this review. Three studies directly compared ultrasound-guided insertion with non-guided insertion, one study evaluated the effectiveness of ultrasound vs. chest X-ray for the detection of insertion-related complications, and the remaining studies (n=10) were non-comparative regarding imaging use. The most common insertion-related outcomes were insertion success/failure (n=8), positioning (n=5), insertion attempts (n=3), and procedural difficulty (n=2). Insertion failure ranged from 0.0% to 14.7%, first attempt/site success ranged from 60.5% to 100%, malposition ranged from 1.3% to 21.7%, and reported difficulty during the procedure ranged from 0.0% to 12.5%. Ultrasound-guided CVC insertion was favored compared to non-guided insertion in the three comparative studies, which evaluated mechanical complications, clinical complications, and healthcare resource utilization.

Conclusion: The overall burden associated with the insertion of current non-tunneled CVCs is high and varies across insertion sites, patient populations, and regions. Comparative studies demonstrate a clear reduction in complications for image-guided insertion compared to non-guided insertion.