Efficacy and safety of ultrasound-guided infraclavicular axillary vein cannulation for centrally inserted central catheter placement in critically ill patients: systematic review with meta-analysis and trial sequential analysis
Pooled result · Overall cannulation success rateResult — go to the resultRelative risk 0.98 99% CI 0.95–1.02Authors' conclusion
In critically ill patients, US-guided infraclavicular AXV cannulation is equally effective and safe as US-guided IJV cannulation.
Study context
- Population
- Critically ill patients requiring centrally inserted central venous catheterization
- Participants
- 908 patients · 3 randomized controlled trials (RCTs)
- Comparison
- Ultrasound (US)-guided axillary vein (AXV) vs US-guided internal jugular vein (IJV) cannulation
- Outcome
- Overall cannulation success rate
Methodological detailsrandom-effects inverse variance model, trial sequential analysis, ROB-2 and GRADE, Databases searched from inception until 1 July 2025
- Random-effects inverse variance model
- Trial sequential analysis
- ROB-2 and GRADE
- Databases searched from inception until 1 July 2025
Pooled result
As reported in the abstract
Relative risk
0.98
99% CI 0.95–1.02
P = 0.16
AXV vs IJV
RR 0.98 (99% CI 0.95–1.02); P = 0.16
Further pooled results
| Outcome | RR (99% CI) | P value | |
|---|---|---|---|
| First-pass success rateI2 = 0%, high certainty | 0.93 (0.88–1.00) | P = 0.008 | |
| 0.512Relative risk (log scale) |
First-pass success rate
- Trend toward lower first-pass success with AXV; negligible after alternative testing and trail sequential analysis (TSA)
Trial sequential analysis
- TSA showed equivalence of AXV to IJV for efficacy and safety; optimal information size achieved
Safety
Cumulative mechanical complication rate
- TSA: AXV equivalent to IJV cannulation for safety
Parts of this Brief are withheld: the automatic checks could not confirm them against the abstract.
Original publication
Efficacy and safety of ultrasound-guided infraclavicular axillary vein cannulation for centrally inserted central catheter placement in critically ill patients: systematic review with meta-analysis and trial sequential analysis. Crit Care. Published 30 January 2026. doi:10.
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