Implementation of a Bedside Point-of-Care Ultrasound Program in a Large Academic Neonatal Intensive Care Unit

Vidya V. Pai; Caroline Y. Noh; Reedhi Dasani; Shelby Vallandingham; Christine Manipon; Bereketeab Haileselassie; Jochen Profit; Malathi Balasundaram; Alexis S. Davis; Shazia Bhombal

doi:10.1055/s-0042-1750118

American Journal of Perinatology, Table of Contents

Am J Perinatol 2024; 41(S 01): e76-e84
DOI: 10.1055/s-0042-1750118

Original Article

Implementation of a Bedside Point-of-Care Ultrasound Program in a Large Academic Neonatal Intensive Care Unit

Vidya V. Pai

¹Division of Neonatology, UCSF Benioff Children's Hospital Oakland, Oakland, California

,

Caroline Y. Noh

²Division of Neonatal and Developmental Medicine, Department of Pediatrics, Stanford University School of Medicine, Stanford, California

,

Reedhi Dasani

²Division of Neonatal and Developmental Medicine, Department of Pediatrics, Stanford University School of Medicine, Stanford, California

,

Shelby Vallandingham

²Division of Neonatal and Developmental Medicine, Department of Pediatrics, Stanford University School of Medicine, Stanford, California

,

Christine Manipon

²Division of Neonatal and Developmental Medicine, Department of Pediatrics, Stanford University School of Medicine, Stanford, California

,

Bereketeab Haileselassie

⁴Division of Pediatric Critical Care, Department of Pediatrics, Stanford University School of Medicine, Stanford, California

,

Jochen Profit

²Division of Neonatal and Developmental Medicine, Department of Pediatrics, Stanford University School of Medicine, Stanford, California

³California Perinatal Quality Care Collaborative, Stanford, California

,

Malathi Balasundaram

²Division of Neonatal and Developmental Medicine, Department of Pediatrics, Stanford University School of Medicine, Stanford, California

,

Alexis S. Davis

²Division of Neonatal and Developmental Medicine, Department of Pediatrics, Stanford University School of Medicine, Stanford, California

,

Shazia Bhombal

²Division of Neonatal and Developmental Medicine, Department of Pediatrics, Stanford University School of Medicine, Stanford, California

› Author Affiliations

Abstract

Objectives In the adult and pediatric critical care population, point-of-care ultrasound (POCUS) can aid in diagnosis, patient management, and procedural accuracy. For neonatal providers, training in ultrasound and the use of ultrasound for diagnosis and management is increasing, but use in the neonatal intensive care unit (NICU) is still uncommon compared with other critical care fields. Our objective was to describe the process of implementing a POCUS program in a large academic NICU and evaluate the role of ultrasound in neonatal care during early adaption of this program.

Study Design A POCUS program established in December 2018 included regular bedside scanning, educational sessions, and quality assurance, in collaboration with members of the cardiology, radiology, and pediatric critical care divisions. Core applications were determined, and protocols outlined guidelines for image acquisition. An online database included images and descriptive logs for each ultrasound.

Results A total of 508 bedside ultrasounds (76.8% diagnostic and 23.2% procedural) were performed by 23 providers from December 2018 to December 2020 in five core diagnostic applications: umbilical line visualization, cardiac, lung, abdomen (including bladder), and cranial as well as procedural applications. POCUS guided therapy and influenced clinical management in all applications: umbilical line assessment (26%), cardiac (33%), lung (14%), abdomen (53%), and cranial (43%). With regard to procedural ultrasound, 74% of ultrasound-guided arterial access and 89% of ultrasound-guided lumbar punctures were successful.

Conclusions Implementation of a POCUS program is feasible in a large academic NICU and can benefit from a team approach. Establishing a program in any NICU requires didactic opportunities, a defined scope of practice, and imaging review with quality assurance. Bedside clinician performed ultrasound findings can provide valuable information in the NICU and impact clinical management.

Key Points

Use of point-of-care ultrasound is increasing in neonatology and has been shown to improve patient care.
Implementation of a point-of-care ultrasound program requires the definition of scope of practice and can benefit from the support of other critical care and imaging departments and providers.
Opportunities for point-of-care ultrasound didactics, imaging review, and quality assurance can enhance the utilization of bedside ultrasound.

Keywords

bedside ultrasound - POCUS - program development - ultrasound program

Full Text

References

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