Umbilical Vein Catheterization

Umbilical vein catheterization may be a life-saving procedure in neonates who require vascular access and resuscitation. The umbilical vein remains patent and viable for cannulation until approximately 1 week after birth. After proper placement of the umbilical line, intravenous fluids and medication may be administered to critically ill neonates.

Indications

• Emergency administration of medications and fluids in the delivery room or neonatal intensive care unit.
• Blood sampling.

Contraindications

• Omphalitis
• Necrotizing enterocolitis

Materials needed for the Procedure
3.5 Fr or 5 Fr umbillical catheter, Heparinized saline( 0.5-1 unit/ml ) , 3 way stop cock, syringes, 10% poviodone-iodine preparation, sutures, adhesive tape, sterile cutdown tray, sterile gloves, mask, protective eye wear.

Procedure

1. Put on mask, protective eye wear and sterile gloves. Use aseptic technique and observe standard precautions through out the procedure.

2.Flush a 3.5 Fr or 5fr radiopaque umbilical catheter with heparinized saline ( 0.5 – 1 unit/ml ) attached to a 3 way stopcock.

3. Prepare the umblical cord. Clean the umbilical clamp, stump and a wide area of the surrounding abdominal skin with 10 % poviodine-iodine preparation. Allow it to dry.

4. Holding the umbilical cord firmly with an encircling tie to prevent bleeding, cut it with a scalpel blade 1 cm above the skin attachment.

5. The umbilical vein is identified as a single , large , thin walled oval vessel. It is distinguishable from the two umbilical arteries, which are smaller, thick walled round vessels that are often constricted and extend above the cut surface of the cord.

6. Flush the umbilical catheter with heparinizied saline and evacuate any air bubbles to avoid the possible complications of air embolus to the central circulation.

7. Place the catheter in the inferior vena cava above the level of the hepatic veins and the ductus venosus. Initially insert the umbilical catheter upwards towards the liver , so that the tip is just below the skin and blood can be readily aspirated.

8. Then guide the catheter tip to a depth of 1-4 cm to avoid the portal vessel.

9. Stabilize the catheter with suture , tape or both.

10. assess lower extremities and buttocks for blanching or sudden cyanosis caused by vascular spasm or embolisim.

11. Confirm correct placement of catheter tip radiographically.

Complications

• Vascular compromise
• Hemorrhage
• Air embolism
• Infection
• Thrombosis
• Vascular perforation