Point-of-care ultrasound for central venous catheter confirmation and complications in the emergency department: A systematic review and meta-analysis.

BackgroundCentral venous catheter malposition and pneumothorax remain clinically important complications after insertion. Many emergency departments still rely on post-procedural chest radiography, which may delay catheter use. We evaluated the diagnostic accuracy and workflow impact of point-of-care ultrasound for confirming central venous catheter position and detecting complications in the emergency department.MethodsWe conducted a systematic review and diagnostic test accuracy meta-analysis (International Prospective Register of Systematic Reviews (PROSPERO): CRD420251065638) following the Preferred Reporting Items for Systematic Reviews and Meta-Analyses of Diagnostic Test Accuracy Studies (PRISMA-DTA) and Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) 2020 guidelines. The PubMed, Embase, Cochrane Library, Web of Science Core Collection, and Scopus databases were searched from inception to 1 December 2025. Studies were considered eligible for inclusion if they enrolled adults undergoing internal jugular or subclavian central venous catheter insertion in emergency department settings and compared bedside point-of-care ultrasound (cardiac/contrast-enhanced "swirl/bubble" techniques and/or lung ultrasound) with chest radiography and/or computed tomography. For catheter malposition, pooled sensitivity and specificity were estimated using a bivariate random-effects model; pneumothorax accuracy and time outcomes were summarized descriptively due to sparse events.ResultsA total of eight prospective studies (801 central venous catheter insertions) were included. Seven studies contributed estimable 2 × 2 data for malposition. Point-of-care ultrasound showed pooled sensitivity of 0.81 (95% confidence interval: 0.50-0.95) and specificity of 0.99 (95% confidence interval: 0.96-1.00), with hierarchical summary receiver operating characteristic-area under the curve of 0.99 (95% confidence interval: 0.97-0.99), positive likelihood ratio of 137.83 (95% confidence interval: 22.04-862.02), negative likelihood ratio of 0.19 (95% confidence interval: 0.06-0.62), and diagnostic odds ratio of 737.34. Heterogeneity was substantial (I2: sensitivity = 73.85% and specificity = 83.37%). Pneumothorax specificity was consistently high (97.2%-100%), while sensitivity varied and was often nonestimable in zero-event studies. Pneumothorax severity was rarely reported in the primary studies. Reported time savings versus chest radiography ranged from ∼5-284 min (commonly ∼20-60 min). Deeks' test suggested no significant publication bias (p = 0.86), although power was limited.ConclusionsIn emergency department settings, point-of-care ultrasound provides highly specific and rapid confirmation for detecting central venous catheter malposition, supporting prompt rule-in decisions and potential workflow acceleration. Given heterogeneous sensitivity and limitations of reference standards, negative results should be interpreted cautiously, with confirmatory imaging reserved for equivocal examinations or high-risk scenarios.