Reducing umbilical catheter migration rate by introducing regular POCUS assessment: a quality improvement project

Umbilical venous catheters (UVCs) provide essential vascular access for neonates in the neonatal intensive care unit, yet malpositioning and catheter migration can lead to serious complications.We conducted a quality improvement project at Evelina London Children's Hospital, aiming to reduce UVC-related complications by introducing routine monitoring of UVC tip position after insertion using point-of-care ultrasound (POCUS).A retrospective review was carried out to establish a baseline for current UVC practice at a time when tip position was predominantly confirmed by X-ray. During this initial 6-month period, among 28 preterm infants born at less than 30 weeks' gestation, UVC migration occurred in 57% of cases, with two instances of extravasation injury.This was followed by an intervention period, which included a POCUS training programme for medical staff and the introduction of updated local guidelines recommending POCUS assessment of UVC tip position at insertion and routine follow-up between days 3 and 5 after insertion.In a second 6-month period, we prospectively evaluated POCUS use and UVC migration rates among 28 preterm infants with characteristics comparable to the initial cohort.Following the intervention, POCUS use at insertion increased significantly (82% vs 29%), with an improvement in correct UVC placement at insertion (75% vs 40%). At follow-up between days 3 and 5, UVC migration was still observed in 30% of cases.When migration was detected, the UVC was either removed or repositioned if found within the right atrium. Importantly, no extravasation injuries occurred in the post-intervention group.These findings suggest that POCUS can facilitate early detection of UVC migration and optimise initial line placement, with the potential to reduce severe complications. Routine POCUS monitoring is a practicable strategy to improve UVC management and improve the safety of neonatal care.