Purpose or Case Report: Umbilical catheters (UC) are ubiquitously utilized in neonatal intensive care units (NICU) during the early neonatal stage. Traditionally, these catheters are placed blindly, with the external length of the catheter being used to approximate catheter depth. This then requires subsequent radiographs to be obtained to assess for position, often in a sterile field, with considerable dead time. This exhibit will educate the viewer about the use of ultrasound guidance in the placement of these catheters.
Methods & Materials: Recent literature is reviewed. Approaches utilized with both abdominal ultrasound and echocardiography are discussed. Relevant neonatal anatomy is described. Complications related to malposition are reviewed, and measures related to efficiency and radiation dose are detailed.
Results: The traditional use of radiography to assess umbilical catheter placement in the neonatal population involves ionizing radiation and considerable lag time, yet the two-dimensional data included in this technique still results in only an approximate location for the catheter tip. Atypical vascular anatomy complicates this further, leading to the acquisition of additional radiographs before proper positioning is achieved. Furthermore, the sterile field created for catheter placement is typically maintained during the time of image acquisition and review, and the time lag in imaging interpretation may increase risk for procedure-related infection.

US-guided UC placement has been demonstrated to have equal or often better ability to identify accurate catheter tip positioning, with the added benefit of being performed real-time during the procedure, significantly limiting delays in care and radiation exposure. This has been shown to be particularly true in patients of increased birthweight. This represents an opportunity for radiologists to provide value in the care of these patients. Now that ultrasound resources are increasing in pediatric tertiary care centers, training and comfort with the procedure remain the only significant barrier to adoption.
Conclusions: The use of US guidance for UC placement has significant potential to improve catheter placement accuracy and clinical turnaround time from procedure beginning to final completion. This is an opportunity for radiologists to improve value via ultrasound-guided umbilical catheter placement while minimizing radiation dose to these young patients as consistent with the ALARA principle.