View source for 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<ref>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.</ref>

==Contraindications==
*[[Omphalitis]]
*[[Peritonitis]]
*[[Necrotizing enterocolitis]]

==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==
[[File:UVC-Procedure.png|thumb|]]
#Place patient under warmer
#Hold umbilical stump and scrub with betadine (avoid pooling at patient's sides secondary to to blistering under warmer
#Drape in sterile fashion (leave head exposed for observation)
#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<ref>Ahn W, Bahk JH, Lim YJ. "The “Gauge” System for the Medical Use." Anesthesia & Analgesia. October 2002. 95(4): 1125.</ref>
#*Grab long angiocaths and remove from needle in sterile fashion
#Place purse string suture or umbilical tape at jct of skin and cord to provide hemostasis and to secure line 
#'''Cut cord with scalpel 1 cm from skin'''
#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
#Gently '''advance catheter until blood returns and then advance 1-2 cm more''' (usually a total of 4-5 cm in term infant)
#Secure the catheter using the purse string or umbilical tape and then secure to the patient
#The catheter can be advanced to the IVC using a standardized graph, if CVP monitoring or high concentrations of glucose are indicated
#Confirm catheter location radiographically<ref>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.</ref><ref>Vali P, Fleming SE, Kim JH. Determination of umbilical catheter placement using anatomic landmarks. Neonatology. 2010. 98(4):381-6.</ref>
#*Travels cephalad until passing through ductus venosus
#*In contrast, umbilical arterial catheters travel down into iliac arteries and then cephalad
[[File:Umbilical catheter.gif|thumbnail|Umbilical venous catheter]]
[[File:UVC UAC.jpg|thumbnail|UVC vs. UAC Radiograph]]

==Complications==
#Hemorrhage
#Infection
#Hepatic necrosis (secondary to to injection of sclerosing solutions)
#Air embolism (especially on removal of catheter)
#Catheter tip embolism
#Vessel perforation

==See Also==
*[[Newborn Resuscitation]]

{{Vascular access types}}

==External Links==
*[https://first10em.com/umbilical-vein-catheterization/ First10EM - Umbilical Vein Catheterization]

===Videos===
{{#widget:YouTube|id=CrUnsFy5iGU}}

==References==
<references/>

[[Category:Pediatrics]] [[category:procedures]]
[[Category:Critical Care]]