Right supraclavicular fossa ultrasound view for real-time central venous catheter tip positioning in adult patients: A systematic review

Background and Aims: Central venous catheter (CVC) tip placement within the lower third of the superior vena cava or at the cavo-atrial junction is vital to avoid complications. Chest radiograph (CXR), the standard for post-procedural confirmation, has limitations, including radiation exposure and delay in malposition diagnosis. Ultrasonography (USG) enables real-time tip confirmation. This review aimed to consolidate evidence on the use of right supraclavicular fossa ultrasound view in CVC tip position confirmation in adult patients using radiographic imaging as a reference. Methods: A systematic literature search of Medline via Pubmed, Scopus, Google Scholar, and ResearchGate was conducted from database inception until 14 May 2024. Eligible studies included adults undergoing USG-guided CVC insertion, comparing real-time right supraclavicular fossa ultrasonographic view with CXR or fluoroscopy for optimum CVC tip positioning. Outcomes included correct CVC placement, malposition detection, malposition correction, and complications. Results: From 1,865 records, five observational studies met the inclusion criteria (sample size: 252). Correct CVC tip positioning was confirmed radiographically in 99.16% of the cases. Three studies reported a pooled malposition rate of 7.89% using the right supraclavicular fossa ultrasound view. Among the pooled malpositions, 87.33% were corrected intra-procedurally using the right supraclavicular fossa ultrasonographic view. No complications occurred during repositioning. Conclusion: The right supraclavicular fossa ultrasound view appears to be useful in real-time confirmation of CVC tip position and facilitates intra-procedural correction of malposition. However, the findings are limited by the small overall sample size, heterogeneity among included studies, and the absence of diagnostic accuracy.