Point-of-Care Ultrasound for Central and Peripheral Line Procedures in Neonates

An educational module on point-of-care ultrasound for central line procedures in neonates was developed for this DNP scholarly project. Point-of-care ultrasound for central line procedures is currently underutilized in the neonatal population. Most critically ill neonates require central line access for fluid management, parenteral nutrition, lab draws, blood pressure monitoring, and medications. Central line insertion problems and malposition are two complications that may occur. Using point-of-care ultrasound for central line procedures can improve first-attempt success rates and the accuracy of catheter position, potentially decreasing complications. Many tertiary Newborn Intensive Care Units (NICUs) along the Wasatch Front do not use point-of-care ultrasound for central line procedures because providers have limited education on how to use this tool. Therefore, education for Wasatch Front providers is needed. The objectives for this project were to: (a) create a neonatal point-of-care ultrasound educational module for central line procedures targeting level III NICU providers along the Wasatch Front, (b) present the point-of-care ultrasound educational module to providers along the Wasatch Front, (c) evaluate the effectiveness of the neonatal point-of-care ultrasound educational module by doing a course evaluation, and (d) present the point-of-care ultrasound education and evaluation results to a NICU administration committee. Point-of-care ultrasound is used in a variety of adult specialties. However, neonatal specialists have been slow to adopt point-of-care ultrasound because of limited training, costs, and medical liability concerns. Several recent studies have shown that using point-of-care ultrasound for central line procedures improves attempt rates and procedural time and decreases complications. Providers find it difficult to locate the catheter tip position by using X-ray alone. Researchers have suggested that ultrasounds are a superior tool to radiographs when determining central line position. The project proceeded as follows: (a) participation in the Neonatology Point-of-Care Ultrasound Course November 19 and 20, 2016 at the Children's Hospital of Philadelphia (CHOP); (b) working with an emergency physician using point-of-care ultrasound on patients to learn more about central line insertion and malposition; (c) development of an introductory educational module using ultrasound for central line procedures; (d) submission of an IRB application for project approval; (e) distribution of an educational module, course evaluation and competency check list to several NICU providers and (f) presentation of educational module, evaluation results, and competency checklist to a NICU administration committee. In summary, this project has important implications for NICU providers who care for neonates with central lines. This educational module will help providers become more comfortable using point-of-care ultrasound to assist in central line procedures and may lead to implementation of point-of-care ultrasound in NICUs along the Wasatch Front.