Umbilical vein catheterization

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 patient'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
• Access options