Point of Care Ultrasound with the Bedside X-ray in Umbilical Catheter Tip Confirmation in Neonates—An Open Label Randomized Controlled Trial

Background Neonates in the neonatal intensive care unit (NICU) require umbilical venous and arterial catheter placement as part of their intensive care. The use of bedside ultrasound is increasing to confirm the tip position of these catheters. Objective To establish the utility of bedside ultrasound for determining the tip position of umbilical catheters in neonates. Design Open-label, randomized controlled trial. Methodology The study was conducted at a tertiary care NICU in India from September 2017 to June 2019. Neonates admitted to the NICU who required umbilical catheterization, including both umbilical venous and arterial catheters, were included. Interventions Ultrasound group (USG)-guided umbilical catheter tip confirmation. Outcome Measures The following parameters were compared between the USG and radiography (X-ray) groups for determining the position of both umbilical catheters. Primary Time taken to determine the tip. Secondary Number of X-rays taken and number of manipulations required. Results A total of 72 neonates were randomized into two groups: the USG and the X-ray group. Each group had 36 neonates. The mean gestational age was 30.81 ± 4.58 weeks and 31.22 ± 4.05 weeks in the X-ray and USG groups, respectively. The mean time taken for confirmation of the tip of both umbilical catheters was 7.11 ± 1.79 min in the USG group and 20.22 ± 8.00 min in the X-ray group. The mean time taken to confirm the tip using ultrasound was significantly less than with X-ray ( P < .001). A significantly greater number of manipulations was required to get the optimal position of the catheter tips in the X-ray group compared to the USG group. The mean number of X-rays required in the X-ray group was statistically significant in comparison to the USG. Conclusion Bedside ultrasound is an effective and time-efficient method to guide umbilical catheter insertion and tip confirmation.