Central Line-associated Bloodstream Infection in Surgical Patients: Impact of Ultrasound Guided Insertion

Abstract

Background:
Central line–associated bloodstream infection (CLABSI) remains a major preventable complication in surgical and perioperative care. Ultrasound guidance improves central venous catheter (CVC) placement safety, but its effect on CLABSI is unclear.
Methods:
PubMed was searched using systematic search strategy with humans and English filters. Randomized trials and cohort studies comparing real-time ultrasound-guided versus landmark CVC insertion in surgical/perioperative or surgical-critical-care patients (adults and children) were included, and findings were synthesised narratively without meta-analysis.
Results:
Of 1,183 records identified, 273 duplicates were removed; 910 titles/abstracts were screened and 58 full texts assessed, yielding 9 included studies. Ultrasound guidance increased cannulation success with improved first-pass performance, and reduced mechanical complications (e.g., carotid puncture 1.7% vs 8.3%). Infection outcomes were heterogeneous: one trial reported lower catheter-associated bloodstream infection (10.4% vs 16.0%), a prospective cohort found no association (hazard ratio 0.69; 95% CI 0.36–1.30), whereas a post hoc analysis reported higher CRBSI hazard with ultrasound (hazard ratio 2.21; 95% CI 1.17–4.16).
Conclusions:
Ultrasound-guided CVC insertion consistently improved procedural performance and reduced mechanical harm, while evidence for CLABSI/CRBSI reduction was inconsistent and context dependent. Ultrasound should be implemented as the default insertion approach within comprehensive insertion-and-maintenance bundles for surgical patients.