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Am J Perinatol
DOI: 10.1055/a-2358-6632
Original Article

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

John T. Wren Jr.
1   Division of Neonatology, Department of Pediatrics, University of Iowa Hospitals and Clinics, Iowa City, Iowa
,
Azadeh Eslambolchi
2   Division of Pediatric Radiology, Mallinckrodt Institute of Radiology, Washington University, St. Louis, Missouri
,
Kristen Clark
3   Neonatal Intensive Care Unit, Saint Louis Children's Hospital, BJC Healthcare, St. Louis, Missouri
,
Tasnim Najaf
4   Division of Newborn Medicine, Department of Pediatrics, Washington University, St. Louis, Missouri
› Author Affiliations Funding Funding was generously provided by the Division of Newborn Medicine, Washington University in Saint Louis.
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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.


Supplementary Material



Publication History

Received: 15 April 2024

Accepted: 26 June 2024

Accepted Manuscript online:
02 July 2024

Article published online:
19 July 2024

© 2024. Thieme. All rights reserved.

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