Ultrasound Image Capture during Central Venous Catheter Insertions: A Quality Improvement Study

Area of Science:

• Pediatric critical care medicine
• Medical quality improvement
• Ultrasound technology in medicine

Background:

• Central venous catheter (CVC) insertion is a common pediatric intensive care unit (PICU) procedure with inherent risks.
• Ultrasound guidance can mitigate risks associated with CVC insertion.
• Accurate documentation of guidewire position is crucial for safe CVC placement.

Purpose of the Study:

• To describe a quality improvement initiative focused on increasing ultrasound documentation of correct guidewire position during CVC insertions in the PICU.
• To implement and evaluate a novel workflow for capturing and uploading ultrasound images into the electronic health record.

Main Methods:

• A quality improvement project guided by a specific, measurable, achievable, relevant, time-based (SMART) aim and a key driver diagram.
• Failure modes and effects analysis (FMEA) was used to identify potential failures in the image capture and upload process.
• Plan-Do-Study-Act (PDSA) cycles were implemented to refine the workflow and improve success rates.

Main Results:

• The study involved 270 central venous catheter insertions between July 2023 and March 2025.
• The novel workflow achieved a monthly high of 64% for successful ultrasound image capture and upload.
• The electronic health record order process for image upload reached a monthly high of 100% completion.

Conclusions:

• A novel workflow was developed and implemented to enhance ultrasound image capture during CVC insertions in the PICU.
• The initiative provided valuable insights into optimizing ultrasound image capture for improved CVC insertion safety.
• Continued efforts are underway to achieve the primary objective of maximizing ultrasound documentation rates.