#401 - 🔵 [NEO CONFERENCE] - What are the best entry points for starting a POCUS program in your unit?

Hello friends 👋

Live from the Neo Conference in Las Vegas, Ben and Daphna sit down with Dr. Zach Anderson from Winnie Palmer Hospital to demystify the integration of Point of Care Ultrasound (POCUS) in the NICU. Moving beyond the intimidation of complex cardiac scans, Zach explains why starting with "pinch points" like vascular access or bladder volume can revolutionize bedside decision-making. From the SAFER protocol to managing the agitated infant on ECMO, this episode explores how POCUS serves as a powerful problem-solving tool that bridges the gap between clinical mystery and immediate intervention.

Link to episode on youtube: https://youtu.be/O-7lqflJ3Sg

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Short Bio: Dr. Zachary Anderson earned his medical degree from the University of Florida College of Medicine and completed his pediatrics residency at the Vanderbilt University Medical Center and remained there to complete his fellowship in neonatology. Dr Anderson enjoys resident education and has received teaching awards in residency and fellowship. His medical interests are Point of Care Ultrasound (POCUS), neonatal hemodynamics, and extracorporeal membrane oxygenation (ECMO). He has given abstract and platform presentations in neonatology and pediatric cardiology in various meetings, such as NeoHeart and Pediatric Academic Society.

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The transcript of today's episode can be found below 👇

[00:01.166] Ben Courchia MD: Hello everybody, welcome back to The Incubator Podcast.

[00:05.000] We're back at the Neo conference in Las Vegas, Nevada, and we are joined by Zach Anderson from Winnie Palmer in Orlando, Florida. It's funny that we're all in Florida, and yet Nevada is really the place.

[00:11.876] Daphna Yasova Barbeau MD: A neighbor.

[00:16.824] Daphna Yasova Barbeau MD: Yeah, we struggle to get together in Florida, don't we? That's true, that's very true. Well, we're here. We surprised you with audio and video so people can find us wherever you stream the podcast and on the YouTube channel.

[00:19.714] Zach Anderson MD: Big state.

[00:32.042] Ben Courchia MD: And you are an active participant of the conference. You were working with the Point of Care Ultrasound workshop yesterday.

[00:38.64] Zach Anderson MD: Yes, it was yesterday; it was all day. Very nice.

[00:41.698] Ben Courchia MD: So what do you teach people on a Point of Care Ultrasound workshop?

[00:45.166] Zach Anderson MD: Kind of a few different parts of POCUS. I think as we start teaching people about it, people want to know not just the skills, but then also things like, "How do I start a POCUS program?" And so this year it was obviously skills, and we had some lectures, and then there were two hands-on formats where we had live participants come in and scan them—some smaller children and things like that. So we got to have people get hands-on skills at two different parts, and then would go back to lecture. We had some case-based formats as well where we have cases and integrate all the information we had learned. But there were also a few lectures where, like I mentioned, "How do I do this at my unit? What are some of the pitfalls?" And a lot of Q&A where it was a little bit more conversational. So I thought it was really good. We had about 50 people out there and a wide variety—a lot of physicians and nurse practitioners. I thought it was a pretty good event for the most part. We had a few hiccups, as with any POCUS.

[01:45.486] Ben Courchia MD: With people, perfection is the enemy of good enough, right? They're like, "Well, how do I start?" and it's like, just put the probe on the thing and see what you see.

[01:52.76] Zach Anderson MD: Well, a lot of people see a POCUS program and they think, "I've got to have cardiac, lung, vascular access, cranium, and a SAFER protocol," all these different things. And at least how I got into POCUS at all was just start small. Vascular access is a real easy entry point, or lung is an entry point. Bladder is a very easy one. Yeah, exactly. To your point, Ben, just put the probe on and start learning how to use it. Because I think a lot of people think this is so complicated and once you start doing it, it makes a lot of sense. There are really very few things you're actually doing.

[02:25.794] Ben Courchia MD: People have a process with which they do certain things.

So this is not altering the process, but like we were saying for the bladder, you put the probe on and it gives you a piece of information.

[02:36.878] Daphna Yasova Barbeau MD: I think the bladder scan is very rewarding. Very rewarding.

[02:40.227] Ben Courchia MD: And if you don't see anything, then you say, "I can't see anything. I'm going to go with my usual steps."

[02:45.438] Zach Anderson MD: Right. This happens all the time. We had a kid on ECMO who was extremely tachycardic and agitated, and we were worried that maybe a cannula had migrated. What's going on? His urine output was going down, but everything else seemed okay. This is a really common cause of agitation in the elderly in the MICU—elderly patients who have a Foley and can't urinate, and they're just getting a lot of medications. But what they need to do is pee. It was the same thing for us; we had a baby like that.

[03:14.158] Daphna Yasova Barbeau MD: We had a baby like that where—

[03:19.342] Zach Anderson MD: If we weren't doing a lot of POCUS yet, we would have found out much sooner. It's a total bifurcation in your thinking. Okay, you've got a kid with oliguria—is it an obstruction from the Foley or is it oliguric renal failure? I'm terribly worried about one, but the other is an easy fix. You can just start irrigating the Foley. So I think that's a really great point where all you have to do is look. It takes two seconds. You don't even have to do volumetrics. Put the probe on: is there a big bladder and you've got a Foley in? It's not working.

[03:31.054] Daphna Yasova Barbeau MD: It's totally different.

[03:47.598] Zach Anderson MD: So get the Foley out, flush it, and replace it.

[03:50.24] Ben Courchia MD: And you could set up a system that is simple. You could use your one probe, your hockey stick, and say, "Okay, that's the probe I use." I'm not going to get too fancy with the different probes and depths and hertz and so on.

[04:05.000] And then you can have a few systems and just know how to basically orient yourself on the picture.

[04:08.428] Zach Anderson MD: Start small, get something that's what we call a pinch point. What's a problem in your unit? I was talking to one of the nurse practitioners who was there; she's in a big cardiac unit. They're really needing arterial access more than they ever have because these kids are sick, they're getting ABGs frequently, and they're having trouble putting A-lines in. Great, that's a perfect application for POCUS. So just get good at A-lines. That's it. And then grow out if you want, and whatever your system needs, go from there. It was good; we had a lot of conversations about that.

[04:36.594] Daphna Yasova Barbeau MD: I'm always interested—we've done a POCUS workshop. What were the cases? How do you narrow down the right cases for the workshop?

[04:44.822] Zach Anderson MD: It's kind of a few flavors. I think people want an exciting case where there's some mystery. Some kind of clinical mystery. A good example was a tiny baby, a 28-weeker who's six days old, doing fine on bubble CPAP, has a line in, and decompensates. There are lots of things that could be, but at least for our fellows, what I want them to be capable of doing at the end of their training is integrate head, lung, heart, and abdomen ultrasound all in one quick sweep that can take less than 20 seconds.

[05:19.949] Daphna Yasova Barbeau MD: Like a FAST scan.

[05:20.59] Zach Anderson MD: Yeah, like a FAST scan. It's called the SAFER protocol—something that people often use. You quickly cruise around and exclude these life-limiting things that often kill babies. Does the baby have a pneumothorax? We're not looking for trace pneumos, we're looking for big, bad pneumos. You can do that in two seconds. No pericardial effusion. Is there a big IVH that's causing exsanguination? No. Is the kid perforated? Is there a subcapsular hematoma? That's a little hard sometimes to show, but you can do all those things really quick and do them in the middle of the night. In my opinion, the more "normal" you see, the more—

[06:05.134] Ben Courchia MD: It's a breeze because I've had a patient just like that where they're like, "Well, we think pericardial effusion but we're not sure." Who can know, right?

It's 11 p.m. and if you don't have POCUS, it means I need to call Radiology to get an ultrasound, I need to call Cardiology to get an echo... No, I did exactly what you did. No big IVH, no big pericardial effusion, massive pleural effusion. Done. I know what the problem is.

[06:32.206] Zach Anderson MD: Yes, problem solve; put a needle in that. I think it's also just helpful to remember our adult colleagues have been doing this for 20 years. It's totally integrated into their work, their residency, and often their fellowship. It's 2026 and there are guidelines from 2007 about using ultrasound for PICCs. It takes a lot of time, but that's a good application of it. I thought it was a good way to get it into the lifeblood of neonatology. It obviously already is, and everyone wants the skills, so how do we get people trained is the next thing we're working on.

[07:11.042] Ben Courchia MD: Very cool. Well, Zach, what else? Is your job done at the conference?

[07:15.598] Zach Anderson MD: I'm going to go to some talks, get some little gifts for my kids. I haven't had a great chance to look at the schedule yet, but I think Ariel Salas has a talk on NEC and those sort of things. That's something I've always wanted to learn more about. He doesn't know me, but I have a PubMed alert for him and I read everything he writes.

[07:19.916] Ben Courchia MD: And which talk are you looking forward to?

[07:38.67] Ben Courchia MD: He's always very practical and starts with a question where you're like, "Yep, I've been wondering that for a while now. Thank you for doing the study."

[07:45.888] Zach Anderson MD: Exactly. Anything he does, I want to read. So I'm looking forward to seeing him.

[07:50.514] Daphna Yasova Barbeau MD: Yeah, we'll see him later. He's talking about optimizing nutrition in ELBW infants and advances in care for the 22 to 24-week preemie. I think we're all looking forward to that.

[07:58.446] Zach Anderson MD: That would be good. We have a lot of those.

[08:01.376] Ben Courchia MD: Awesome. Thank you for dropping by. Enjoy the conference.