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Question
Can the use of point of care ultrasound (POCUS) during umbilical venous catheter (UVC) insertion reduce the number of malpositions, manipulations, radiation exposure and complications compared with the use of X-ray to confirm UVC position?
Scenario
While working on a neonatal unit, you look after a baby born at 38 weeks who was admitted with persistent pulmonary hypertension of the newborn (PPHN), requiring an umbilical venous catheter (UVC) insertion. Prior to the completion of the X-ray, the neonatal consultant carries out an echocardiography to assess the pulmonary circulation. Incidentally, it is recognised that the UVC tip was in the heart, necessitating manipulation of the UVC to a satisfactory position under ultrasound (US) guidance. X-ray was later completed, confirming a satisfactory position of the UVC tip.
You wonder how many malpositions, repeated manipulations, re-insertions, repeated X-ray exposures and handling of the neonates can be avoided if point of care ultrasound (POCUS) was used for UVC insertion and positioning, as an adjunct to the standard X-ray.
Structured clinical question
Does the use of real-time ultrasound or POCUS during UVC insertion, in neonates of any gestational age, reduce the number of UVC malpositions, manipulations, re-insertions, radiation exposure and complications compared with the use of X-ray to confirm UVC position?
Search
We searched the Medline, EMBASE, CINAHL, EMCARE, BNI, PUBMED and COCHRANE using the EBSCOhost interface, limiting to articles published after 1950, using the following search strategy: (‘Neonate’ OR ‘newborn’ OR ‘Infant’ using expanders and Boolean search) AND (‘Umbilical venous catheter’ OR ‘UVC’ using expanders and Boolean search) AND (‘ultrasound’ OR ‘point of care ultrasound’ OR ‘POCUS’ using expanders and Boolean search). We performed the search in August 2023.
A total of 57 articles were found from the search. Three relevant systematic review articles were found, and an additional five references from these were screened. We excluded case studies. …
Footnotes
X @DrHarshaGowda
Contributors NR initiated the review, formed the clinical question and completed the literature search. Both NR and HG independently reviewed the titles, abstracts and full-text articles. NR drafted the manuscript. HG proofread a few drafts and with further input, strengthened the quality of the article. We would like to thank our local librarian PO for assisting us with the literature search.
Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.
Competing interests None declared.
Provenance and peer review Not commissioned; externally peer reviewed.
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