Enhancing accuracy: point-of-care ultrasound for rapid confirmation of central line placement in neonates—an observational study

To assess the diagnostic accuracy of point-of-care ultrasound against single or multiple check X-rays done to confirm central line position. This cross-sectional observational study was conducted in a tertiary neonatal intensive care unit from March 2023 to March 2024. Point-of-care Ultrasound (USG) and radiograph were performed on infants who underwent central line placement. Diagnostic accuracy of USG was presented by sensitivity, specificity, PPV, NPV, positive likelihood ratio, and negative likelihood ratio. Of the 160 central lines, 109 (68.1%) vs. 102(63.8%) central lines were defined as optimally placed on the radiograph and POCUS, respectively. The sensitivity and specificity of POCUS in confirming central line tip position were 93.58% and82.35%, respectively. The positive predictive value and the negative predictive value were 91.89% and 85.71%, respectively. The positive likelihood ratio was 5.3%, and the negative likelihood ratio was 0.08%. Overall accuracy of POCUS to radiography was 90% [95% confidence interval (CI) 84.27-94.18]. The study also revealed that a significantly shorter time was required in bedside POCUS with a mean duration of 4 minutes as compared to X-ray where the mean duration was 19 minutes. Point-of-care ultrasound can be used as an alternative to bedside radiographic examination in confirming the catheter tip position with diagnostic accuracy of 90%.