Umbilical vein catheterization

Indications

1. Emergency access and stabilization of the newly born

Equipment Needed

1. Fluid chamber, IV tubing, infusion pump, filter (0.22 µm), short length of IV tubing, three-way stopcock
2. Umbilical artery catheter (3.5 to 5 Fr)
3. 3-0 silk suture on a curved needle
4. Curved iris forceps without teeth
5. Small clamps, forceps, scissors, needle holder
6. 10 mL of heparinized solution for flush (1–2 units heparin per milliliter of fluid)
7. 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