Ultrasound-guided vascular access in the neonatal intensive care unit: a nationwide survey

Abstract

Ultrasound guided percutaneous vascular access (USG-PVA) is recommended by international practice guidelines but information regarding its use in the neonatal intensive care unit (NICU) is lacking. Our objective was to assess neonatologist's perceptions and current implementation of USG-PVA in Spain. This was a nationwide online survey. The survey was composed of 37 questions divided in 4 domains: 1) neonatologist's background, 2) NICU characteristics, 3) personal perspectives about USG-PVA and clinical experience in USG-PVA. One hundred and eighty survey responses from 59 NICUs (62% of Spanish NICUs) were analyzed. Most neonatologist (81%) perceive that competence in USG-PVA is indispensable or very useful in clinical practice. However, 64 (35.5%) have never used USG-PVA in real patients. Among neonatologists with some experience in USG-PVA most perform less than 5 procedures per year (59% in venous access and 80% in arterial access) and a 38% and 60% have never used USG for venous and arterial access respectively in very low birth weight infants (VLBWI). Spanish neonatologists report that residents/fellows training in USG-PVA is absent (52.2%) or unstructured (32%) in their units. The lack of adequate training is identi ed by a 60% of neonatologists as the most important barrier for implementation of USG-PVA and 87% would recommend that future neonatologists receive formal training. In conclusion, Spanish neonatologists perceive that USG-PVA is important in clinical practice but, currently these techniques are largely underused. Our results indicate that speci c training in USG-PVA should be implemented in the NICU.What'S Known -Ultrasound guided vascular access is recommended as the preferred method for central venous access and arterial line placement in children and adults -The degree of current implementation of ultrasound for vascular access in the NICU and the perceptions of neonatologist about its use are largely unknown.WHAT'S NEW -Most neonatologists consider that competence in ultrasound guided vascular access is an indispensable aid for clinical practice.-However, most neonatologists are not adequately trained in ultrasound guided vascular access and the technique is largely underused.