Umbilical vein catheterization
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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
- Place pt 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)
- 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
- 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 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
- The catheter can be advanced to the IVC using a standardized graph, if CVP monitoring or high concentrations of glucose are indicated
Complications
- Hemorrhage
- Infection
- Hepatic necrosis (2/2 to injection of sclerosing solutions)
- Air embolism (especially on removal of catheter)
- Catheter tip embolism
- Vessel perforation
See Also
Source
- Roberts: Clinical Procedures in EM, 5th ed