Use of Point-of-Care Ultrasound for Central Line Placement: A Quality Improvement Project

OBJECTIVE: Point-of-care ultrasound (POCUS) is a reliable tool and is slowly being incorporated into neonatal care. Central line (CL) placement is the most common procedure in the neonatal intensive care unit. Radiographs remain the current standard to confirm the location of the central line tip (CLT). Catheters often need adjustments with multiple radiographs. A quality improvement (QI) project was designed to use POCUS and increase the percentage of CLs needing only 1 x-ray to confirm CLT location by 25% in 1 year. METHODS: CLs placed between July 2021 and February 2024 were included. There were 3 key drivers: POCUS training, promoting POCUS acceptance, and standardizing the scanning process. The primary outcome was the percentage of CLs placed with POCUS that required only 1 x-ray to confirm placement. The secondary outcome was the number of inadvertently placed arterial peripherally inserted central catheters (PICCs). Process measures were the percentage of providers competent to use POCUS and the percentage of CLs inserted and checked with POCUS. Statistical process control charts were used for analysis. RESULTS: Targeted interventions increased the percentage of CLs that needed only 1 x-ray from 35% to 57%. Forty-eight percent of providers were competent, and 47% of CLs were assessed by POCUS. Five PICCs were inadvertently inserted into an artery during the baseline vs zero after the interventions. CONCLUSION: QI methodology and targeted interventions were associated with a reduction of radiographs in neonates requiring CL placement to confirm position and a reduction in the inadvertent arterial insertion of PICCs.