Neonatal-Perinatal Medicine Fellow Penn State Health Children's Hospital Hershey, Pennsylvania, United States
Background: Point-of-care ultrasound (POCUS) is gaining increasing demand as a modality to guide and verify umbilical line placement in neonates. Using POCUS allows providers to guide umbilical catheters to the correct vessels and increases the likelihood of central placement. Previous studies have shown that POCUS is safe and effective in identifying catheter tip location, with accuracy comparable to x-rays. POCUS further allows for more rapid insertion and reduction of time needed for line placement, exposure to radiation, and healthcare cost. POCUS is not yet utilized in our level IV, academic NICU. The purpose of this quality improvement (QI) project is to introduce POCUS and evaluate the impact of utilizing POCUS in umbilical line placement in VLBW and ELBW infants admitted to our unit. Objective: Increase utilization of POCUS for umbilical line placement in VLBW and ELBW infants to 50% in two years. Design/Methods: Methods: This QI project involves a retrospective and prospective chart review following application of the following initiatives: (1) Provider education on using POCUS for umbilical line placement using a series of didactic lectures and hands-on simulation modules using ballistic gels models in our Simulation Lab, (2) Provider training in the NICU on using POCUS for identification of umbilical catheters and catheter tip location on infants during line placement procedure and for surveillance of tip location of existing lines post-placement.
Results: Our retrospective chart review revealed a mean 3 x-rays are obtained to confirm placement per infant, with an average wait time of 22min. Our success rate for central UVC placement is 77%, and 20% of UVCs are pulled back to low-lying. Participants had no prior experience with using ultrasound. POCUS training was made available to all providers. Eleven providers (42%) completed the didactic and hands-on training. A second round of training is planned. Prospective chart review is ongoing.
