NICE guidelines for central venous catheterization in children. Is the evidence base sufficient?

Background. Recent guidelines from the National Institute for Clinical Excellence (NICE) recommend the use of ultrasound guidance for central venous catheterization in children. This study prospectively examined the use of ultrasound guidance for central venous catheterization in children undergoing heart surgery. Methods. One hundred and twenty-four infants and children were randomized to either ultrasound-guided or traditional landmark-guided central venous catheterization. Results. Success rates were significantly greater in the landmark group compared with the ultrasound group (89.3% vs 78%, P<0.002), and arterial puncture rates were significantly lower in the landmark group (6.2% vs 11.9%, P<0.03). There was no significant difference between the two groups in the time taken to perform the catheterization. Conclusions. These results are different from the published results on which the NICE guidelines were based; however, the evidence base in children is small. There is currently insufficient evidence to support the use of ultrasound guidance for central venous catheterization in children.