Improving PICC Placement Using Bedside Ultrasound in a Level IV NICU: A Quality Improvement Project.

BACKGROUND: Accurate peripherally inserted central catheter (PICC) tip placement in neonates is critical to prevent complications and minimize repeated radiographic exposure. Reliance on radiography may delay confirmation and increase radiation risk in this vulnerable population. PURPOSE: To evaluate the impact of a standardized point-of-care ultrasound (POCUS) protocol on PICC placement accuracy, radiographic utilization, and procedural efficiency in a Level IV neonatal intensive care unit (NICU). METHODS: A longitudinal pre-post quality improvement design compared early (March-May 2025) and later (August-October 2025) implementation phases. A consecutive sample of 145 neonates requiring PICC placement was included. The intervention incorporated real-time ultrasound guidance, bubble test confirmation of tip position, and image documentation performed by credentialed providers. Outcomes included POCUS utilization, number of radiographs, line adjustments, sterile procedure time, and central line-associated bloodstream infection (CLABSI). Data were analyzed using χ2 and independent samples t-tests (P ≤ .05). RESULTS: POCUS utilization increased from 7% to 27% (P = .001). POCUS-guided insertion was associated with higher rates of single radiograph confirmation (92% vs. 42%, P < .001). No difference in total radiographs was observed. Sterile procedure time increased in the later phase (P = .026). No CLABSI occurred in the POCUS group. IMPLICATIONS FOR PRACTICE AND RESEARCH: Implementation of a POCUS-guided PICC protocol improved confirmation efficiency and reduced reliance on multiple radiographs. Increased sterile time likely reflected early adoption and workflow integration. Findings support continued implementation with ongoing training; however, additional prospective studies with larger samples are needed before widespread adoption can be recommended.