SLIDE 1 Department of Newborn Care
Other uses of Point of Care Ultrasound in the NICU
Nick Evans Royal Prince Alfred Hospital and University of Sydney. Sydney, Australia.
SLIDE 2 Department of Newborn Care
Clinical uses of Clinician Performed Ultrasound in the NICU
- Localisation of intravascular catheters.
- Lung Ultrasound
- Recognition of pleural, peritoneal, pericardial
fluid.
- Other cardiac, CHD, tamponade, transport
- Abdominal Ultrasound
- Locating blood loss.
- Central line insertion
SLIDE 3 Department of Newborn Care
Catheter Localisation
SLIDE 4
Location of Lines
SLIDE 5
Transducer position to image superior cavo-atrial junction
SLIDE 6
Normal Superior Cavo-atrial Junction.
SLIDE 7
Location of Lines
SLIDE 8
Location of Lines
SLIDE 9
Location of Lines
SLIDE 10
Location of Lines
SLIDE 11
Location of Lines
SLIDE 12
Location of Lines
SLIDE 13
Transducer position for inferior cavo-atrial junction.
SLIDE 14
Location of Lines
SLIDE 15
Other uses. Location of Lines
SLIDE 16
Prevention of UVC extravasation
SLIDE 17 Department of Newborn Care
Normal Portal Vein Anatomy
Remnant of Umbilical Vein
SLIDE 18 Department of Newborn Care
Normal Portal Vein Anatomy
Remnant of Umbilical Vein
SLIDE 19
Neonatal Intra-Hepatic Umbilical Vein Anatomy
SLIDE 20
Transducer position to image Ductus Venosus Atrial Junction.
SLIDE 21
Normal 2D Image
Pars Umbilicus Ductus Venosus
SLIDE 22
Normal Colour Doppler Image
Pars Umbilicus Ductus Venosus
SLIDE 23
X-ray: UVC through the DV
SLIDE 24
UVC through the DV
SLIDE 25
UVC too far through the DV
SLIDE 26
UVC through the DV
SLIDE 27
Is this UVC in the Ductus Venosus?
SLIDE 28
UVC Ultrasound
SLIDE 29
UVC Ultrasound
DV
SLIDE 30
UVC Ultrasound
SLIDE 31
UVC Ultrasound ?
SLIDE 32
UVC: Air in Portal Vein.
SLIDE 33 Department of Newborn Care
Lung Ultrasound
SLIDE 34
Lung Ultrasound
SLIDE 35
Lung Ultrasound A-Lines
SLIDE 36
Lung Ultrasound A-Lines
SLIDE 37
Lung Ultrasound: Loss of A-Lines
SLIDE 38
Lung Ultrasound: Loss of A-Lines
SLIDE 39
Lung Ultrasound: No Pneumothorax Pleural Sliding and Comet Tails
SLIDE 40
Lung Ultrasound: Pneumothorax No Pleural Sliding or Comet Tails
SLIDE 41
M-mode Ultrasound: No Pneumothorax Waves on a sandy beach.
SLIDE 42
M-mode Ultrasound: Pneumothorax Stratosphere or Barcode
SLIDE 43
Fluid in the wrong place: Pleural Effusions
Diaphragm Costo-Phrenic Angle Lung
SLIDE 44
Fluid in the wrong place: Pleural Effusions
SLIDE 45
Cause of Pleural Fluid
SLIDE 46 Department of Newborn Care
Other Cardiac Uses
SLIDE 47
Fluid in the wrong place: Pericardial Sac
SLIDE 48
Fluid in the wrong place: Pericardial Sac
SLIDE 49
Chest Xray to site PICC
SLIDE 50
To drain fluid in the wrong place: Pericardocentesis
Aspiration Cannula Tip
SLIDE 51
To drain fluid in the wrong place: Pericardocentesis
SLIDE 52
Recognition of CHD Baby transferred as PPHN
SLIDE 53
Unexpected Detection of CHD
SLIDE 54 Department of Newborn Care
Other uses. In Neonatal Transport?
SLIDE 55 Department of Newborn Care
Ultrasound in Newborn Transport
SLIDE 56 Department of Newborn Care
In Neonatal Transport
SLIDE 57
101 uses for an iPhone
SLIDE 58 Department of Newborn Care
Where’s the blood gone?
SLIDE 59
Where’s the blood gone? Massive Cerebral Haemorrhage
SLIDE 60 Where’s the blood gone?
- Term baby, transferred ex-utero as HIE.
- On arrival
– Borderline hypovolaemic – Coagulopathic – Hb 163 g/L to 82g/L – FFP and blood resuscitation
SLIDE 61 Where’s the blood gone?
- 27 weeks, HMD, ventilated, surfactant,
umbilical lines.
- Acute hypovolaemic deterioration at 4 hrs.
N-Saline and blood resus
- Hb from 130g/L to 50g/L
- Cerebral Ultrasound: small GMH
- Liver Ultrasound: no bleed.
SLIDE 62
Where’s the blood gone?
Bladder Haematoma
SLIDE 63 Department of Newborn Care
Acute Abdominal Ultrasound
SLIDE 64
Fluid in the wrong place: Ascites
SLIDE 65
Abdominal Ultrasound: NEC Intramural gas
SLIDE 66
Intraluminal Gas
SLIDE 67
Abdominal Ultrasound: NEC with portal venous gas
SLIDE 68
Abdominal Ultrasound: Dead gut
SLIDE 69 Department of Newborn Care
Insertion of Central Lines?
SLIDE 70
Insertion of Central Lines?
Internal Jugular Lt Common Carotid
SLIDE 71 Department of Newborn Care
Conclusions
- Point of care ultrasound in the NICU
goes beyond the heart and the brain.
- We’re discovering potential new uses all
the time.
- Ultrasound skills will inevitably become a
mandatory component of neonatal training.
- POCU does not conflict with, rather it
complements, consultative ultrasound.
SLIDE 72 Department of Newborn Care
Thank you
