Real-time Point-of-care Ultrasound (POCUS) for Neonatal Peripherally Inserted Central Catheter (nPICC) Tip Confirmation in a Tertiary Neonatal Unit—A Cohort Study

Aim To evaluate the impact of real-time point-of-care ultrasound (POCUS) for confirming neonatal peripherally inserted central catheter (nPICC) tip position compared to routine X-ray-based assessment. Methods Single-centre cohort study from May 2022 to July 2024, conducted at a tertiary neonatal intensive care unit in the UK. Results First-attempt optimal tip position was higher with POCUS at 70.1% (47/67) versus 52.8% (47/89) in the non-POCUS group ( P = .042) but was not significant after adjustment (adjusted odds ratio [aOR] 0.42; 95% confidence interval [CI]: 0.09-1.54; P = .224). POCUS significantly increased the odds of requiring a single X-ray (aOR = 8.4; 95% CI: 2.24-42.10; P = .003). Radiation exposure and X-ray-associated costs were significantly lower in the POCUS group ( P < .001). Catheter line-associated bloodstream infection (CLABSI) rates were lower in the POCUS group (2.9% vs 5.6%), though not statistically significant. Conclusions Real-time POCUS might improve first-attempt nPICC placement, reduce the need for repositioning and X-rays, lower radiation exposure and reduce cost. It represents a feasible and potentially cost-effective alternative to X-ray confirmation and merits consideration for routine use in neonatal care.