Point-of-care ultrasound for umbilical venous catheter placement and surveillance in neonates: practical guidance and governance

Abstract Umbilical venous catheters (UVCs) are essential in neonatal intensive care, yet malposition and early migration are common and can cause serious hepatic or cardiac injury. We set out a structured, image-based approach to UVC placement and surveillance using point-of-care ultrasound (POCUS). We undertook a targeted narrative review of literature from 2005 to 2025, drawing on comparative studies, systematic reviews, meta-analyses, and society guidance on neonatal POCUS and vascular access. Findings were synthesised into a continuous bedside workflow covering placement, real-time correction of malposition, surveillance, and governance. POCUS directly visualises the UVC tip at the inferior vena cava–right atrial junction and detects portal, hepatic, and intracardiac malposition more reliably than radiography (reported sensitivity and specificity for cavoatrial localisation > 90% vs 60–70%). Tip migration occurs in 50–90% of neonates within the first 72 h, so a single confirmatory scan at insertion is insufficient. A three-view protocol (situs, subcostal IVC–RA, coronal/oblique) combined with a multi-probe approach reduces misclassification: the curvilinear probe maps the intrahepatic course, the linear probe confirms the tip, and the phased-array probe is reserved for cardiac views. Operator-dependent ultrasound artefact misidentification is a key clinical pitfall that requires multi-planar confirmation and explicit competency standards. Conclusion : A three-view, multi-probe POCUS protocol improves UVC tip confirmation, allows earlier correction of malposition, and detects migration sooner than repeat radiography. Safe local adoption requires recognition of operator-dependent artefact pitfalls within a structured training and governance framework. What is Known: • Radiography for UVC tip confirmation is indirect and frequently misclassifies portal sinus malposition .• Tip migration occurs in up to 90% of neonates within 72 h, exposing infants to ongoing hepatic and cardiac risk . What is New: • A structured three-view, multi-probe POCUS protocol that directly localises the UVC tip and distinguishes portal, hepatic, and intracardiac malpositions at the bedside .• Recognition and mitigation of operator-dependent pitfalls, addressed alongside placement, surveillance, and governance as one practical bedside workflow .