Systemized Systemic Sono-screening (S4) Protocol: Initial Findings

We are developing a systemized protocol for major-system sonographic screening, an extended physical examination in critically ill infants.This program includes a brief examination of the brain, heart, lungs, intestine, and genitals.We also check the central line catheters for correct positioning and complications such as thrombi.This protocol gives more information than the traditional point-of-care ultrasound (POCUS) developed over the past two decades.In our recent screening of medical records, we have noted a high incidence of intracardiac thrombi in the right cardiac chambers.Some of these thrombi could well result from the longer durations for which umbilical venous catheters (UVCs) were used, but not every patient had undergone umbilical venous catheterization.The perception of lower blood flow velocities on the right side as a causative factor may also not be entirely correct; the hemodynamic measurements may vary at specific location(s) within the vessels/ chambers, at various time-points in the cardiac cycle, and with physiological conditions such as ventricular hypertrophy.The high frequency of clots in the right heart chambers needs evaluation in larger, carefully designed studies.