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

Author:

Wren John T.1,Eslambolchi Azadeh2,Clark Kristen3,Najaf Tasnim4

Affiliation:

1. Division of Neonatology, Department of Pediatrics, University of Iowa Hospitals and Clinics, Iowa City, Iowa

2. Division of Pediatric Radiology, Mallinckrodt Institute of Radiology, Washington University, St. Louis, Missouri

3. Neonatal Intensive Care Unit, Saint Louis Children's Hospital, BJC Healthcare, St. Louis, Missouri

4. Division of Newborn Medicine, Department of Pediatrics, Washington University, St. Louis, Missouri

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

Publisher

Georg Thieme Verlag KG

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