Umbilical vein catheterization: Difference between revisions
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== Indications ==
== Indications ==
#Emergency access and stabilization of the newly born
*Emergency access and stabilization of the newly born


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


== Procedure ==
== Procedure ==
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#Hold umbilical stump and scrub with betadine (avoid pooling at pt's sides 2/2 to blistering under warmer
#Hold umbilical stump and scrub with betadine (avoid pooling at pt's sides 2/2 to blistering under warmer
#Drape in sterile fashion (leave head exposed for observation)
#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)
#Flush catheter (3.5 Fr for preterm to '''5 Fr for term newborns''') and attach to '''three-way stopcock''')
#Place purse string suture or umbilical tape at jct of skin and cord to provide hemostasis and to secure line  
#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
#'''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)
#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"'''
##'''Feed the "mouth"'''
#Gently advance catheter until blood returns and then advance 1-2cm more (usually a total of 4-5 cm in term infant)
#Gently '''advance catheter until blood returns and then advance 1-2cm 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 pt
#Secure the catheter using the purse string or umbilical tape and then secure to the pt
#The catheter can be advanced to the IVC using a standardized graph, if CVP monitoring or high concentrations of glucose are indicated
#The catheter can be advanced to the IVC using a standardized graph, if CVP monitoring or high concentrations of glucose are indicated

Revision as of 15:51, 2 December 2014

Indications

  • Emergency access and stabilization of the newly born

Equipment Needed

  • Fluid chamber, IV tubing, infusion pump, filter (0.22 µm), short length of IV tubing, three-way stopcock
  • Umbilical artery 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 pt under warmer
  2. Hold umbilical stump and scrub with betadine (avoid pooling at pt's sides 2/2 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)
  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)
    1. Feed the "mouth"
  8. Gently advance catheter until blood returns and then advance 1-2cm 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 pt
  10. The catheter can be advanced to the IVC using a standardized graph, if CVP monitoring or high concentrations of glucose are indicated

Complications

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

See Also

Newborn Resuscitation

Source

  1. Roberts: Clinical Procedures in EM, 5th ed
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