Umbilical vein catheterization

Indications

  • Emergency access and stabilization of the newly born with lack of peripheral access
  • Remains viable and patent until ~1 week after birth[1]

Contraindications

Equipment Needed

  • Fluid chamber, IV tubing, infusion pump, filter (0.22 µm), short length of IV tubing, three-way stopcock
  • Umbilical catheter (3.5 to 5 Fr)
  • 3-0 silk suture on a curved needle
  • Curved iris forceps without teeth
  • Small clamps, forceps, scissors, needle holder
  • 10 mL of heparinized solution for flush (1–2 units heparin per milliliter of fluid)
  • Sterile drapes, surgical cap, mask, gown, and gloves

Procedure

  1. Place patient under warmer
  2. Hold umbilical stump and scrub with betadine (avoid pooling at patient's sides secondary to to blistering under warmer
  3. Drape in sterile fashion (leave head exposed for observation)
  4. Flush catheter (3.5 Fr for preterm to 5 Fr for term newborns and attach to three-way stopcock)
    • If emergency and UVC kit not available, consider 3.5 Fr ≈ 18.5 gauge and 5 Fr ≈ 16 ga[2]
    • Grab long angiocaths and remove from needle in sterile fashion
  5. Place purse string suture or umbilical tape at jct of skin and cord to provide hemostasis and to secure line
  6. Cut cord with scalpel 1 cm from skin
  7. Identify the vein (larger, thin walled vessel usually at 12 o'clock position that continues to bleed. usu 2 arteries, 1 vein)
    • Feed the "mouth"
    • Gently dilate catheter with forceps, clearing thrombus
  8. Gently advance catheter until blood returns and then advance 1-2 cm more (usually a total of 4-5 cm in term infant)
  9. Secure the catheter using the purse string or umbilical tape and then secure to the patient
  10. The catheter can be advanced to the IVC using a standardized graph, if CVP monitoring or high concentrations of glucose are indicated
  11. Confirm catheter location radiographically[3][4]
    • Travels cephalad until passing through ductus venosus
    • In contrast, umbilical arterial catheters travel down into iliac arteries and then cephalad
Umbilical venous catheter
UVC vs. UAC Radiograph

Complications

  1. Hemorrhage
  2. Infection
  3. Hepatic necrosis (secondary to to injection of sclerosing solutions)
  4. Air embolism (especially on removal of catheter)
  5. Catheter tip embolism
  6. Vessel perforation

See Also

References

  1. Butler-O'Hara M, Buzzard CJ, Reubens L, McDermott MP, DiGrazio W, D'Angio CT. A randomized trial comparing long-term and short-term use of umbilical venous catheters in premature infants with birth weights of less than 1251 grams. Pediatrics. 2006 Jul. 118(1):e25-35.
  2. Ahn W, Bahk JH, Lim YJ. "The “Gauge” System for the Medical Use." Anesthesia & Analgesia. October 2002. 95(4): 1125.
  3. Hoellering AB, Koorts PJ, Cartwright DW, Davies MW. Determination of umbilical venous catheter tip position with radiograph. Pediatr Crit Care Med. 2014 Jan. 15(1):56-61.
  4. Vali P, Fleming SE, Kim JH. Determination of umbilical catheter placement using anatomic landmarks. Neonatology. 2010. 98(4):381-6.