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 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 be a potential barrier in our implementation and has not been previously described in the literature. We plan to further study the difficulty with POCUS implementation in our NICU to improve the process to benefit our program and our patients.
We agree with the author’s recommendation to develop a formal POCUS curriculum and competencies assessment and strongly recommend an approach that helps identify additional barriers of implementation that are unique to the NICU care model and patient demographics.
Acknowledgements
We would think to thank the Meriter Foundation for the financial support to purchase our point of care ultrasound (Grant No. 638).
Compliance with ethical standards
Conflict of interest
The authors declare that they have no conflict of interest.
Footnotes
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