New publication: Ultrasound‐guided arterial cannulation in the paediatric population

Christian K RaphaelNour A El Hage ChehadeJoanne KhabsaElie A AklMarie Aouad-MarounRoland Kaddoum

Published on March 3, 2023

Ultrasound use for insertion of arterial catheters in children 
Plain language summary


An arterial catheter is a thin tube that can be inserted into an artery to monitor blood pressure during complex surgeries and during stays in intensive care. Ultrasound (an imaging method that uses sound waves to capture live images of soft tissue) can help doctors to locate the artery and insert the catheter. In children in particular, ultrasound may reduce the need for multiple needle sticks, the occurrence of haematoma (a collection of blood outside the blood vessels) and damage to the artery, compared with other techniques such as palpation of the artery (feeling through the skin for the pulse) or Doppler auditory assistance (listening for a change to a higher pitch at the exact location of the artery).

The authors aimed to find out whether ultrasound offers any advantages over palpation of the artery or Doppler auditory assistance. Specifically, to find out if ultrasound improved the following outcomes:

1. How often doctors can successfully insert the catheter on first attempt
2. The occurrence of complications such as haematoma and injury caused by reduced blood flow
3. How often doctors can successfully insert the catheter on the first two attempts
4. How often doctors can successfully insert the catheter after several attempts
5. The average number of attempts needed to insert the catheter
6. How long it takes to insert the catheter

What did the authors do?

They searched the literature for controlled clinical studies comparing use of ultrasound with traditional ways of placing a catheter into an artery in children under the age of 18 years. They compared and summarised the results of the studies and rated our confidence in the evidence-based on factors such as study methods and sizes.

What did they find?

They found nine eligible studies: eight comparing ultrasound with palpation and one comparing ultrasound with Doppler auditory assistance. Seven studies were of radial artery cannulation and two studies were of femoral artery cannulation. Four studies did not mention any funding source and five studies had departmental funds. The studies included children aged from under one month to 18 years.

Main results

The authors found that ultrasound guidance compared with traditional methods probably increases the rate of successful cannulation on first attempt, within the first two attempts, and after several attempts. Ultrasound guidance probably reduces the occurrence of haematoma, the number of attempts needed to successfully place an arterial catheter, and the time needed to perform successful cannulation. The evidence suggests that ultrasound is probably superior for arterial cannula insertion in children and adolescents, including very young children.

Limitations of the evidence

The confidence in the evidence is only moderate because it was impossible to mask the doctors performing the cannulation (they knew which children had ultrasoundassisted cannulation), and because the studies included few children and reported few events.


The evidence is up to date to October 2022.

Read the full review at the Cochrane Library