Ignacio Oulego-Erroz1,2,3,4, Almudena Alonso-Ojembarrena5,6,7, Victoria Aldecoa-Bilbao5,8,9, María Del Carmen Bravo5,10, Jon Montero-Gato5,11, Rocío Mosqueda-Peña5,12,13, Antonio Rodríguez Nuñez5,14,15,16. 1. Pediatric Intensive Care Unit, Complejo Asistencial Universitario de León, Altos de Nava s/n, 24002, Leon, Spain. ignacio.ouelgo@gmail.com. 2. Working Group On Ultrasound, Spanish Society of Neonatology (SENeo), Valencia, Spain. ignacio.ouelgo@gmail.com. 3. Working Group On Bedside Ultrasound, Spanish Society of Pediatric Intensive Care (SECIP), Madrid, Spain. ignacio.ouelgo@gmail.com. 4. Biomedicine Institute of León, University of León, Leon, Spain. ignacio.ouelgo@gmail.com. 5. Working Group On Ultrasound, Spanish Society of Neonatology (SENeo), Valencia, Spain. 6. Neonatal Intensive Care Unit, Hospital Universitario Puerta del Mar de Cádiz, Cadiz, Spain. 7. Research Unit, Biomedical Research and Innovation Institute of Cádiz (INiBICA), Puerta del Mar University Hospital, Cadiz, Spain. 8. Neonatal Intensive Care Unit, Hospital Clinic Barcelona, Barcelona, Spain. 9. Center for Maternal-Fetal and Neonatal Medicine (BCNatal), Barcelona, Spain. 10. Neonatal Intensive Care Unit, Hospital Universitario La Paz, Madrid, Spain. 11. Neonatal Intensive Care Unit, Hospital Universitario Basurto, Bilbao, Spain. 12. Neonatal Intensive Care Unit, Hospital Universitario, 12 de Octubre, Madrid, Spain. 13. Research Institute Hospital, 12 de Octubre (imas12), Madrid, Spain. 14. Pediatric Emergency, Intermediate and Critical Care Unit, Complejo Hospitalario de Santiago de Compostela, Santiago de Compostela, Spain. 15. Health Research Institute of Santiago de Compostela (IDIS), Santiago de Compostela, Spain. 16. CLINURSID Research Group, University of Santiago de Compostela, Santiago de Compostela, Spain.
Abstract
Ultrasound-guided vascular access (USG-VA) is recommended by international practice guidelines but information regarding its use in the neonatal intensive care unit (NICU) is lacking. Our objective was to assess neonatologist's perceptions and current implementation of USG-VA in Spain. This was a nationwide online survey. The survey was composed of 37 questions divided in 4 domains: (1) neonatologist's background, (2) NICU characteristics, (3) personal perspectives about USG-VA, and (4) clinical experience in USG-VA. One-hundred and eighty survey responses from 59 NICUs (62% of Spanish NICUs) were analyzed. Most neonatologists (81%) perceive that competence in USG-VA is indispensable or very useful in clinical practice. However, 64 (35.5%) have never used USG-VA in real patients. Among neonatologists with some experience in USG-VA most perform less than 5 procedures per year (59% in venous access and 80% in arterial access) and a 38% and 60% have never used USG for venous and arterial access, respectively, in very low birth weight infants (VLBWI). More than a half of neonatologists (55.5%) use US to check catheter tip location but a 46.6% always perform a radiography for confirmation. Spanish neonatologists report that resident/fellow training in USG-VA is absent (52.2%) or unstructured (32%) in their units. The lack of adequate training is identified by a 60% of neonatologists as the most important barrier for implementation of USG-VA and 87% would recommend that future neonatologists receive formal training. CONCLUSION: Spanish neonatologists perceive that USG-VA is important in clinical practice but currently, these techniques are largely underused. Our results indicate that specific training in USG-VA should be implemented in the NICU. WHAT IS KNOWN: • Ultrasound-guided vascular access is recommended as the preferred method for central venous access and arterial line placement in children and adults. • The degree of current implementation of ultrasound for vascular access in the NICU and the perceptions of neonatologist about its use are largely unknown. WHAT IS NEW: • Most neonatologists consider that competence in ultrasound-guided vascular access is an indispensable aid for clinical practice. • However, most neonatologists are not adequately trained in ultrasound-guided vascular access and the technique is largely underused.
Ultrasound-guided vascular access (USG-VA) is recommended by international practice guidelines but information regarding its use in the neonatal intensive care unit (NICU) is lacking. Our objective was to assess neonatologist's perceptions and current implementation of USG-VA in Spain. This was a nationwide online survey. The survey was composed of 37 questions divided in 4 domains: (1) neonatologist's background, (2) NICU characteristics, (3) personal perspectives about USG-VA, and (4) clinical experience in USG-VA. One-hundred and eighty survey responses from 59 NICUs (62% of Spanish NICUs) were analyzed. Most neonatologists (81%) perceive that competence in USG-VA is indispensable or very useful in clinical practice. However, 64 (35.5%) have never used USG-VA in real patients. Among neonatologists with some experience in USG-VA most perform less than 5 procedures per year (59% in venous access and 80% in arterial access) and a 38% and 60% have never used USG for venous and arterial access, respectively, in very low birth weight infants (VLBWI). More than a half of neonatologists (55.5%) use US to check catheter tip location but a 46.6% always perform a radiography for confirmation. Spanish neonatologists report that resident/fellow training in USG-VA is absent (52.2%) or unstructured (32%) in their units. The lack of adequate training is identified by a 60% of neonatologists as the most important barrier for implementation of USG-VA and 87% would recommend that future neonatologists receive formal training. CONCLUSION: Spanish neonatologists perceive that USG-VA is important in clinical practice but currently, these techniques are largely underused. Our results indicate that specific training in USG-VA should be implemented in the NICU. WHAT IS KNOWN: • Ultrasound-guided vascular access is recommended as the preferred method for central venous access and arterial line placement in children and adults. • The degree of current implementation of ultrasound for vascular access in the NICU and the perceptions of neonatologist about its use are largely unknown. WHAT IS NEW: • Most neonatologists consider that competence in ultrasound-guided vascular access is an indispensable aid for clinical practice. • However, most neonatologists are not adequately trained in ultrasound-guided vascular access and the technique is largely underused.
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