Affordable Implementation of a Point-of-Care Ultrasound Program in a Large Tertiary Neonatal Intensive Care Unit to Assess Umbilical Venous Catheter Tips and Aid Central Placement

Abstract

Objective This study aimed to implement a point-of-care ultrasound (POCUS) program into a large neonatal intensive care unit (NICU) to enhance care by improving (1) umbilical venous catheter (UVC) tip identification and (2) central placement.

Study Design A POCUS program was established with core providers who received training from external and internal experts. A prospective study (n = 94) compared the accuracy of UVC identification between neonatology-performed ultrasound (NeoUS) and X-ray relative to a referent of radiology-interpreted ultrasound. Finally, an ultrasound-guided UVC insertion protocol was introduced to rescue noncentral traditionally placed catheters (n = 37).

Results Program implementation trained six providers for a total cost of approximately $10,500 USD. NeoUS was more accurate than X-ray at identifying UVC location (81.9 vs. 60.6%) with improved sensitivity and specificity (80.0 and 84.6 vs. 52.5 and 66.7%, respectively). POCUS guidance was able to rescue 89.2% of catheters that were originally noncentral.

Conclusion POCUS implementation in a large NICU is feasible, affordable, and can improve quality of care.

Key Points

• POCUS implementation is feasible and affordable.

• POCUS is more accurate than X-ray at monitoring UVCs.

• Central UVC placement can be increased with POCUS.

Keywords

point-of-care ultrasound - POCUS - UVC - central line

Ethical Statement

This study was approved by the Institutional Review Board of the Washington University in Saint Louis School of Medicine as a quality improvement study, and the need for informed consent was waived.

Publication History

Received: 15 April 2024

Accepted: 26 June 2024

Accepted Manuscript online:
02 July 2024

Article published online:
19 July 2024

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