Advertisement

Neonatal intensive care unit nurse training in identifying ultrasound landmarks in the neonatal mediastinum. Α training program for nurses in North-Eastern Greece

      Highlights

      • Tutoring NICU nurses to recognise basic mesothoracic structures by ultrasound
      • Training improved the ability to accurately identify more lung structures
      • Collaboration of nurses and interdisciplinary teams can benefit high-risk infants

      Abstract

      Purpose

      To demonstrate methods and landmarks for mediastinum ultrasound as part of ultrasound examination of the lung for nurses. This will be the first step in their education to detect finally the tubes and lines malpositioning in order to distinguish emergency conditions of the lungs in neonates hospitalized in neonatal intensive care units.

      Design and methods

      Theoretical and practical interventions were developed to create a 3-month training program based on similar medical courses. The study was approved by the hospital's ethics committee.The program was performed in the neonatal intensive care unit of a single academic institution. Participating nurse was supervised by a paediatric surgeon and trained in lung ultrasound (a safe method without radiation) by a paediatric radiologist.

      Results

      During the practical period (2 months), the neonatal intensive care unit nurse examined 50 neonates (25 + 6–40 + 4 weeks gestational age; 21 males) separated into two subgroups of 25 neonates each for each training month. In the first month under supervision, the nurse was trained to recognise the aortic arch, the right pulmonary artery, the esophagus, the tracheal air, and the ‘sliding lung sign’ in the anterior, lateral, and posterolateral aspects of the thoracic cage. In the second month, the nurse recorded the ultrasound examinations. The identified structures were then assessed and graded by the supervising radiologist. The overall estimated success rate (5 landmarks × 25 neonates = 125) was 90.4%.

      Conclusions

      Although this is the first report of the design of a ‘hands-on’, lung ultrasound training program for neonatal intensive care unit nurses, our findings demonstrate that it is a safe and useful program for all neonatal intensive care unit nurses because theoverall success rate of the 3-month program was determined by accurate identification of basic anatomical structures (90,4%) by the nurse.

      Practice implications

      This study describes the first educational training program for NICU nurses designed to recognise basic structures in the neonatal mediastinum. If the program is effective, NICU nurses will be able to identify respiratory emergencies. NICU nurses can inform doctors about emergencies according to tubes and lines malpositioning in a timely manner to avoid negative consequences.

      Keywords

      To read this article in full you will need to make a payment

      Purchase one-time access:

      Academic & Personal: 24 hour online accessCorporate R&D Professionals: 24 hour online access
      One-time access price info
      • For academic or personal research use, select 'Academic and Personal'
      • For corporate R&D use, select 'Corporate R&D Professionals'

      References

        • Ahn J.H.
        • Kwon E.
        • Lee S.Y.
        • Hahm T.S.
        • Jeong J.S.
        Ultrasound-guided lung sliding sign to confirm optimal depth of tracheal tube insertion in young children.
        British Journal of Anaesthesia. 2019; 123: 309-315
        • American Institute of Ultrasound in Medicine
        AIUM practice guideline for the performance of obstetric ultrasound examinations.
        Journal of Ultrasound in Medicine. 2013; 32: 1083-1101
        • Chen S.W.
        • Zhang M.Y.
        • Liu J.
        Application of lung ultrasonography in the diagnosis of childhood lung diseases.
        Chinese Medical Journal. 2015; 128: 2672-2678
        • Gottlieb M.
        • Holladay D.
        • Burns K.M.
        • Nakitende D.
        • Bailitz J.
        Ultrasound for airway management: An evidence-based review for the emergency clinician.
        The American Journal of Emergency Medicine. 2020; 38: 1007-1013
        • Ho M.C.
        • Ker C.R.
        • Hsu J.H.
        • Wu J.R.
        • Dai Z.K.
        • Chen I.C.
        Usefulness of lung ultrasound in the diagnosis of community-acquired pneumonia in children.
        Pediatrics and Neonatology. 2015; 56: 40-45
        • Lema P.C.
        • O’Brien M.
        • Wilson J.
        • James E.S.
        • Lindstrom H.
        • DeAngelis J.
        • Clemency B.
        Avoid the goose! Paramedic identification of esophageal intubation by ultrasound.
        Prehospital and Disaster Medicine. 2018; 33: 406-410
        • Mele R.
        • Panesar L.E.
        • Heyden M.
        • Sridhar S.
        • Brandon D.
        Neonatal nurse practitioner use of ultrasonography to verify umbilical venous catheter placement in the neonatal intensive care unit.
        Advances in Neonatal Care. 2020; 20: 294-300
        • Pillers D.A.
        Lung ultrasound may allow for timelier surfactant administration and reduce radiograph use.
        The Journal of Pediatrics. 2019; 204: 320-323
        • Poerio A.
        • Galletti S.
        • Baldazzi M.
        • Martini S.
        • Rollo A.
        • Spinedi S.
        • Aceti A.
        Lung ultrasound features predict admission to the neonatal intensive care unit in infants with transient neonatal tachypnoea or respiratory distress syndrome born by caesarean section.
        European Journal of Pediatrics. 2021; 180: 869-876
        • Rose G.
        • Siadecki S.
        • Tansek R.
        • Baranchuk N.
        • Saul T.
        A novel method of assessing for lung sliding using Doppler imaging.
        The American Journal of Emergency Medicine. 2017; 35: 1738-1742
        • Semple T.R.
        • Ashworth M.T.
        • Owens C.M.
        Interstitial lung disease in children made easier…well, almost.
        RadioGraphics. 2017; 37: 1679-1703
        • Sharma D.
        • Tabatabaii S.A.
        • Farahbakhsh N.
        Role of ultrasound in confirmation of endotracheal tube in neonates: A review.
        The Journal of Maternal-Fetal & Neonatal Medicine. 2019; 32: 1359-1367
        • Smit J.M.
        • Haaksma M.E.
        • Winkler M.H.
        • Heldeweg M.L.A.
        • Arts L.
        • Lust E.J.
        • Tuinman P.R.
        Lung ultrasound in a tertiary intensive care unit population: A diagnostic accuracy study.
        Critical Care. 2021; 25: 339
        • Smith C.
        Should nurses be trained to use ultrasound for intravenous access to patients with difficult veins?.
        Emergency Nurse. 2018; 26: 18-24
        • Smith-Bindman R.
        Is computed tomography safe?.
        The New England Journal of Medicine. 2010; 363: 1-4
        • Soldati G.
        • Smargiassi A.
        • Inchingolo R.
        • Buonsenso D.
        • Perrone T.
        • Briganti D.F.
        • Demi L.
        Time for a new international evidence-based recommendations for point-of-care lung ultrasound.
        Journal of Ultrasound in Medicine. Feb. 2021; 40: 433-434
        • Steinwandel U.
        • Gibson N.
        • Towell A.
        • Rippey J.J.R.
        • Rosman J.
        Can a renal nurse assess fluid status using ultrasound on the inferior vena cava? A cross-sectional interrater study.
        Hemodialysis International. 2018; 22: 261-269
        • Stritzke A.
        • Soraisham A.
        • Murthy P.
        • Kowal D.
        • Paul R.
        • Kamaluddeen M.
        • Thomas S.
        Neonatal transport clinician performed ultrasound evaluation of cardiac function.
        Air Medical Journal. 2019; 38: 338-342
        • Swamy V.
        • Brainin P.
        • Biering-Sørensen T.
        • Platz E.
        Ability of non-physicians to perform and interpret lung ultrasound: A systematic review.
        European Journal of Cardiovascular Nursing. 2019; 18: 474-483
        • Tomà P.
        • Owens C.M.
        Chest ultrasound in children: Critical appraisal.
        Pediatric Radiology. 2013; 43 (quiz 1425): 1427-1434
        • Tsou P.Y.
        • Chen K.P.
        • Wang Y.H.
        • Fishe J.
        • Gillon J.
        • Lee C.C.
        • Yu D.T.Y.
        Diagnostic accuracy of lung ultrasound performed by novice versus advanced sonographers for pneumonia in children: A systematic review and meta-analysis.
        Academic Emergency Medicine. 2019; 26: 1074-1088
        • Wang H.C.
        • Tsai M.H.
        • Chu S.M.
        • Liao C.C.
        • Lai M.Y.
        • Huang H.R.
        • Hsu J.F.
        Clinical characteristics and outcomes of neonates with polymicrobial ventilator-associated pneumonia in the intensive care unit.
        BMC Infectious Diseases. 2021; 21: 965
        • Wardlaw T.
        • Salama P.
        • Johansson E.W.
        • Mason E.
        Pneumonia: The leading killer of children.
        Lancet. 2006; 368: 1048-1050
        • Zetlaoui P.J.
        Ultrasonography for airway management.
        Anaesthesia, Critical Care & Pain Medicine. 2021; 40100821