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

Central venous catheter (CVC) insertion is one of the most common interventions in the pediatric intensive care unit (PICU). Although lifesaving, CVC insertion also carries significant risks of morbidity and mortality-risks that ultrasound guidance can help reduce. This study described a quality improvement initiative aimed at increasing the rate of ultrasound documentation of correct guidewire position before vessel dilation during CVC insertions.

This study developed a novel workflow for capturing images from ultrasound machines used during CVC insertions in a PICU and uploading them into the electronic health record. A specific, measurable, achievable, relevant, time-based aim and key driver diagram guided the interventions. A failure modes and effects analysis identified failure points and informed Plan-Do-Study-Act cycles to increase the rate of successful ultrasound image capture and upload.

Between July 1, 2023, and March 31, 2025, critical care fellows and attendings performed 270 new CVC insertions within the PICU. Successful image capture and upload rates reached a monthly high of 64% and a mean completion rate of 58%. The key process metric for placing an electronic health record order required for image upload reached a monthly high of 100% and a mean completion rate of 83%.

This study developed and implemented a novel workflow for PICU proceduralists to increase the rate of ultrasound image capture during CVC insertion. Although work continues toward achieving the primary objective, the study provided key insights into the consistent capture of ultrasound images, supporting enhanced safety during CVC insertion.