Comparison between X-ray and point-of-care ultrasound in localization of umbilical venous catheters in neonates

BackgroundUmbilical venous catheterization provides essential vascular access in neonates, particularly in premature and low-birth-weight neonates. Conventional confirmation using radiography may delay accurate placement and increase radiation exposure.AimTo compare catheter placement confirmation using conventional radiography versus real-time bedside ultrasonography, while evaluating diagnostic performance, procedural efficiency, radiation exposure, and short-term complications.Patients and MethodsA prospective cohort study was conducted on 270 neonates (150 with ultrasound guidance and 120 without) who required umbilical venous catheterization in the neonatal intensive care unit at Children's Hospital, Ain Shams University, from June 2022 to July 2024.ResultsStandard catheter positioning (T7-T9) was achieved in 97.9% of ultrasound-guided cases compared with 70.4% in the non-guided group (p < 0.001). Procedure time until suturing and radiographic confirmation was significantly shorter in the ultrasound group (5.87 ± 1.37 and 14.14 ± 2.15 min) than in the non-ultrasound group (6.90 ± 1.99 and 16.90 ± 3.46 min) (p < 0.001). Ultrasound guidance reduced catheter manipulations and the number of radiographs required. Diagnostic performance of ultrasound showed high sensitivity (95.2%) and accuracy (94.0%). One-month follow-up demonstrated minimal complications.ConclusionUltrasound-guided umbilical venous catheter insertion provides accurate and efficient catheter localization, reduces procedure time and radiation exposure, and offers reliable diagnostic performance. These findings support its routine use in neonatal intensive care units.