Real-Time Insight: Pocus Integration for Optimal Umbilical Vein Catheterization

Abstract

Background: Among the most essential procedures in Neonatal Intensive Care Units (NICUs) is Umbilical Vein Catheterization (UVC), which provides a reliable route for administering life- saving treatments. Point-of-Care Ultrasound (POCUS) is a transformative imaging modality that has redefined procedural accuracy and safety in neonatal care. Existing literature often focuses on procedural time or radiation exposure, without providing a comprehensive evaluation of its impact on success rates and complication reduction. This gap underscores the need for focused studies that assess the effectiveness of POCUS-guided UVC in improving procedural outcomes and neonatal safety.

Aim: To evaluate the effectiveness of Point-of-Care Ultrasound (POCUS) in guiding umbilical vein catheterization (UVC) by assessing its impact on reducing complications and improving procedural success rates in neonates.

Method: A single center, hospital-based comparative, prospective observational study, conducted in the Level IIIA NICU accredited by the National Neonatology Forum (NNF) at Shri Shishu Bhawan Super Speciality Hospital for Children and Newborn, Bilaspur, Chhattisgarh from January 2024 to December 2024. A total of 180 participants were enrolled in the present study. Ninety neonates in POCUS-Guided UVC group underwent UVC under real-time guidance using POCUS. Remaining ninety neonates in Conventional UVC group underwent UVC using the traditional anatomical landmark-based approach without ultrasound guidance. Neonatal outcomes and any adverse events were recorded on the data collection proforma.

Results: The mean time required for catheter placement was significantly lower in the POCUS-guided UVC group (18.6 ± 2.5 minutes) compared to the conventional UVC group (33.4 ± 3.26 minutes, p < 0.0001). The minimum and maximum time for placement in the POCUS group ranged from 15.0 to 23.5 minutes, whereas in the conventional group, it ranged from 28.5 to 38.5 minutes. The need for post-procedural X-ray confirmation was significantly lower in the POCUS-guided UVC group (4.44%) compared to the conventional UVC group (100%, p < 0.0001). A majority of neonates (95.6%) in the ultrasound-guided group did not require an additional X-ray, as the catheter position was confirmed in real-time using POCUS. In contrast, all neonates in the conventional group required at least one confirmatory X-ray to verify catheter placement.

Conclusion: Overall, POCUS-guided UVC placement demonstrated significant advantages over the conventional method by improving procedural efficiency, reducing catheter malposition and migration, lowering complication rates, and minimizing neonatal exposure to radiation.