Other uses of Point of Care Ultrasound in the NICU Nick Evans Royal Prince Alfred Hospital and University of Sydney. Sydney, Australia. 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 Department of Newborn Care
Catheter Localisation Department of Newborn Care
Location of Lines
Transducer position to image superior cavo-atrial junction
Normal Superior Cavo-atrial Junction.
Location of Lines
Location of Lines
Location of Lines
Location of Lines
Location of Lines
Location of Lines
Transducer position for inferior cavo-atrial junction.
Location of Lines
Other uses. Location of Lines
Prevention of UVC extravasation
Normal Portal Vein Anatomy Remnant of Umbilical Vein Department of Newborn Care
Normal Portal Vein Anatomy Remnant of Umbilical Vein Department of Newborn Care
Neonatal Intra-Hepatic Umbilical Vein Anatomy
Transducer position to image Ductus Venosus Atrial Junction.
Normal 2D Image Pars Umbilicus Ductus Venosus
Normal Colour Doppler Image Pars Umbilicus Ductus Venosus
X-ray: UVC through the DV
UVC through the DV
UVC too far through the DV
UVC through the DV
Is this UVC in the Ductus Venosus?
UVC Ultrasound
UVC Ultrasound DV
UVC Ultrasound
UVC Ultrasound ?
UVC: Air in Portal Vein.
Lung Ultrasound Department of Newborn Care
Lung Ultrasound
Lung Ultrasound A-Lines
Lung Ultrasound A-Lines
Lung Ultrasound: Loss of A-Lines
Lung Ultrasound: Loss of A-Lines
Lung Ultrasound: No Pneumothorax Pleural Sliding and Comet Tails
Lung Ultrasound: Pneumothorax No Pleural Sliding or Comet Tails
M-mode Ultrasound: No Pneumothorax Waves on a sandy beach.
M-mode Ultrasound: Pneumothorax Stratosphere or Barcode
Fluid in the wrong place: Pleural Effusions Costo-Phrenic Angle Lung Diaphragm
Fluid in the wrong place: Pleural Effusions
Cause of Pleural Fluid
Other Cardiac Uses Department of Newborn Care
Fluid in the wrong place: Pericardial Sac
Fluid in the wrong place: Pericardial Sac
Chest Xray to site PICC
To drain fluid in the wrong place: Pericardocentesis Aspiration Cannula Tip
To drain fluid in the wrong place: Pericardocentesis
Recognition of CHD Baby transferred as PPHN
Unexpected Detection of CHD
Other uses. In Neonatal Transport? Department of Newborn Care
Ultrasound in Newborn Transport Department of Newborn Care
In Neonatal Transport Department of Newborn Care
101 uses for an iPhone
Where’s the blood gone? Department of Newborn Care
Where’s the blood gone? Massive Cerebral Haemorrhage
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
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.
Where’s the blood gone? Bladder Haematoma
Acute Abdominal Ultrasound Department of Newborn Care
Fluid in the wrong place: Ascites
Abdominal Ultrasound: NEC Intramural gas
Intraluminal Gas
Abdominal Ultrasound: NEC with portal venous gas
Abdominal Ultrasound: Dead gut
Insertion of Central Lines? Department of Newborn Care
Insertion of Central Lines? Internal Jugular Lt Common Carotid
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. Department of Newborn Care
Thank you Department of Newborn Care
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