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

Area of Science:

• Neonatal Intensive Care
• Medical Imaging
• Quality Improvement

Background:

• Umbilical venous catheters (UVCs) are crucial for neonatal vascular access but prone to malpositioning and migration, causing serious complications.
• Current UVC tip confirmation predominantly relies on X-ray, which has limitations in timely detection of migration.

Purpose of the Study:

• To reduce UVC-related complications by implementing routine point-of-care ultrasound (POCUS) for monitoring UVC tip position.
• To evaluate the impact of POCUS on UVC placement accuracy and migration rates in preterm infants.

Main Methods:

• A quality improvement project involving retrospective baseline data (X-ray confirmation) followed by an intervention period.
• Intervention included POCUS training and updated guidelines for UVC tip assessment at insertion and follow-up (days 3-5).
• Prospective evaluation of POCUS use and UVC migration in a comparable cohort of preterm infants.

Main Results:

• POCUS use at insertion increased from 29% to 82% post-intervention, improving correct initial placement from 40% to 75%.
• UVC migration still occurred in 30% of cases at follow-up, but no extravasation injuries were observed post-intervention.
• POCUS facilitated early detection of migration, enabling timely repositioning or removal.

Conclusions:

• Point-of-care ultrasound is a practical strategy for optimizing initial UVC placement and detecting migration early.
• Routine POCUS monitoring can significantly improve UVC management and reduce severe complications in neonatal care.