Introduction of point of care ultrasound into the neonatal intensive care unit
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LETTER TO THE EDITOR
Introduction of point of care ultrasound into the neonatal intensive care unit Adam S. Bauer1 · Ryan Meinen1 · Kelly Devous1 · Awni Al‑Subu2 · Eileen Cowan1 Received: 4 September 2019 / Accepted: 12 December 2019 © Società Italiana di Ultrasonologia in Medicina e Biologia (SIUMB) 2020
We read with great interest the manuscript by Fadel et al., “Point of care ultrasound (POCUS) in Canadian neonatal intensive care units (NICUs): where are we?” As the authors pointed out, there is increasing research suggesting improved patient care with expanding POCUS use in NICUs [1]. However, despite the current widespread use of POCUS in other intensive care and emergency settings, barriers to successful implementation remain surrounding training and maintenance of previously learned POCUS techniques. There is a lack of expert POCUS instructors, as well as a standardization of certification requirements among providers. Achieving competency in POCUS can be remedied by collaborating with colleagues with ultrasound expertise [2]. However, while working together to create a bedside POCUS program, we’ve noticed other barriers to implementation within our own NICU. Our initial use of POCUS, following a traditional 2-day introductory ultrasound course, was to determine central catheter tip location, reduce x-ray imaging, and to improve the accuracy of line placement within our unit. We had planned to use a “train-the-trainer” approach in which a few faculty would rapidly advance their POCUS techniques and show competency through collaboration with our Divisions of Pediatric Cardiology and Radiology. However, we encountered resistance from some team members requesting that POCUS only be used during routine patient’s care times. This resistance initiated secondary to efforts to limit neonatal interventions to routine care times, allowing maximum uninterrupted rest throughout the remainder of the day. As * Eileen Cowan [email protected] 1
2
Division of Neonatology, Department of Pediatrics, University of Wisconsin School of Medicine and Public Health and UnityPoint Health Meriter, 1010 Mount Street Office # 408, Madison, WI 53715, USA Division of Pediatric Critical Care, Department of Pediatrics, University of Wisconsin School of Medicine and Public Health and UnityPoint Health Meriter, Madison, WI, USA
X-ray imaging is still considered the gold standard, POCUS imaging was felt to be a non-essential procedure. These factors prolonged the time to complete the POCUS training necessary to ensure competency in our core group of neonatal providers. Additional education was necessary to help team members understand that POCUS is both safe and beneficial to our neonates. Similar to other uses of ultrasound in the NICU, such as lung ultrasound which has demonstrated substantial reductions in radiation exposure, POCUS can minimize the need for X-ray imaging [3, 4]. POCUS has also been found to be more accurate in determining central catheter tip location [4–6]. This continuing education was not realized to
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