Grant Application

Karena Gildea Lawrence, MD, Children’s Hospital of Pittsburgh of UPMC

Proposed Innovation

Critically ill newborns often require multiple invasive procedures and support devices during their stay in the Neonatal Intensive Care Unit (NICU). Common practices — such as insertion of a central line, or access catheter — expose extremely low birth weight newborns to an average of 26 x-rays during their hospital stay.

Research shows that the risk of cancer from radiation exposure is two to three times higher in infants compared to the average population and six to nine times higher than that of a 60-year-old. This project aims to significantly reduce infant radiation exposure through the use of Point-of-Care Ultrasound (POCUS) in the NICU.

Improvements in Action

Through this project, an innovative educational curriculum will be developed to train providers how to use bedside ultrasound for central line placement. The initial 3-hour training session will address core topics such as ultrasound fundamentals (image generation, acquisition, and optimization) and vascular access (differentiating artery v. vein, cannulation techniques, and catheter tip location). In addition, novel neonatal ultrasound simulators — a mannequin-based model for central line simulations and a vessel phantom with infant sized vessels for vascular access — will be built to provide realistic ultrasound guided insertion training.


Learner accuracy will be evaluated during the hands-on drills by comparing ultrasound and x-ray results. In addition, patient data will be collected on the number of x-rays and procedure duration to compare outcomes of central lines placed with and without ultrasound.

The project is expected to demonstrate that NICU clinicians can be taught how to use POCUS and that implementing its use in the NICU will decrease radiation exposure and procedure duration for central line placement.