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Top Ten Tips for New Paediatric POCUS providers

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Do you have an ultrasound device that seems to do nothing but collect dust? Does your department have a hand-held ultrasound machine that iss locked away all the time? Are you a pro in ultrasound-guided vascular access, and would like to expand your POCUS horizons? Have you recently thought about becoming a POCUS provider? Is a half-day course at a conference going to give you everything you need? 

Disclaimer: This is an easy-to-read blog post with a somewhat clickbait-y title. This is by no means ‘timeless manual’ sort of writing, but these tips may help you if you’re in an early phase of your POCUS journey.

1. The key to becoming competent

It is a good idea to look for a POCUS course near you. A conference-based workshop can be a great taster but inferior to a dedicated, module-based, ultrasound course. The best courses will allow at least a half-day of hands-on training per topic (lungs, basic heart, abdominal, vascular access, etc). More importantly, I believe that you should maximise your pre-course learning as much as possible. You will probably receive a course manual, but do not stop there. Have a good surf on the internet and leave no theoretical learning to the course. You’ll find fantastic POCUS-themed free open access medical education websites and excellent POCUS tweeters. Choose video clips for learning rather than still images. 

2. Practice, practice and practice

After you have completed a POCUS module, have a plan for how you will practice and keep up your skills. Before scanning patients, get to know your ultrasound machine – otherwise known as knob-ology. There are many ways to start: negotiate some scanning shifts, re-arrange your job plan, and use the down-time on your clinical duties (like when nothing happens in the middle of a night shift). Always explain to patients, and their families, that you are a beginner and that you are looking to acquire images of normal anatomy only. After that you can dive deep and learn more about the limitations of POCUS. At this stage it is really important to find a local mentor to help guide you through the perils and pitfalls of POCUS

3. Save your images (if your local policy allows it)

Embrace the idea of quality assurance from the start. You need to be able to save ultrasound images and clips that show standard views and planes, and others need to be able to interpret them. You should actually show your saved clips (yes, even if there’s nothing abnormal on them) so you get valuable feedback on teh views you have obtained. There are two key points to consider here: firstly, permanently remove every detail that could identify a given patient or case. Secondly, always check with your hospital’s legal department if you are allowed to store de-identified patient data.

4. Not a solo act

If you think that training is done and you’re ready to jump in as the new POCUS Rambo, it is still not too late to get yourself partners, friends and allies. Think about joining a group like the Emergency Medicine Ultrasound Group. Ask around and find out which colleagues might be interested in POCUS. Touch base with the local paediatric radiologists and cardiologists. Some of them may be interested in supporting you. In my experience, POCUS not only made me a better clinician but helped build bridges between those other departments that use ultrasound. Prepare your arguments well, why you want to start using POCUS, coupled with the possible benefits. Start with something relatively specific and locally relevant. Some examples of successful first projects:

– peripheral IVs for junior doctors 
– peripheral IVs for nurse-led IV teams
– scanning for ductus arteriosus patency
– ruling out pneumothoraces in PICUs when portable X-rays is not readily available
– Using ultrasound to detect or rule out different effusions (single regions or E-FAST)
– sonography for fractures

5. Share your success stories

POCUS has the potential for delivering more accurate diagnostics and safer procedures. Patients will benefit from this effect, and that your time to parade. If you’re planning to share details of a story outside the regular (formal or informal) hospital discussion, I would advise you to get written consent from the patient/family. If you would like to post an image with a case vignette online, wait a couple of weeks (then a couple of months more, and ideally a couple of years after that) and only upload if it still feels fine. 

6. There is an online POCUS community out there

Reach out to any of us online via email or Twitter. We all do this all of the time. Ask about the reasoning behind which device to purchase. Ask about POCUS politics. Generally, if you hit any sort of wall, remember, you are probably not the first one to do so. Think outside your usual circle because in POCUS, adult providers are always a couple of steps ahead.

7. Haters gonna hate

This is entirely out of your control, so don’t let them get to you.

8. Pro tip: Keep logs

Procedure logs are helpful if you’re in the process of mastering any skill because you will be forced to reflect on what took place. Record what went well and what to do differently next time. Logging your POCUS exams can be helpful if formal credentialing is introduced.

9. Pro tip: Become an influencer

Every time you perform a scan, talk to people around you and explain why you performed the scan; simply put, go out there and get others hooked. The scale of ‘around you’ is up to you, but remain inclusive.

10. Some resources to help

https://www.coreultrasound.com/

https://www.pocus101.com

https://www.thepocusatlas.com

https://litfl.com/ultrasound-library/

Some arguments for POCUS:

https://www.thepocusmanifesto.com

https://link.springer.com/article/10.1007/s00134-021-06486-z

https://pubmed.ncbi.nlm.nih.gov/32093763/

https://link.springer.com/article/10.1007/s00247-021-05184-8

https://journals.sagepub.com/doi/10.1177/0846537119898004

Clip de-identifier app:

https://www.coreultrasound.com/clipdeidentifier/

Look after your machine, charge it and care for your cables:

https://twitter.com/casualtysrus/status/1451928119338754051?s=20&t=zQurFwJV76yFbWsyPPLWpA

About the authors

  • Paediatric Intensive Care consultant with passionate interest in point-of-care ultrasound and FOAMed. Proud European, rookie globalist. He/Him.

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