Umbilical Vein Catheterization
INDICATIONS
■ Vein: Need for emergent vascular access in newborns. The umbilical vein
remains patent for about a week after birth.
■ Artery: Need for frequent monitoring of arterial blood gases and BP.
CONTRAINDICATIONS
■ Peripheral access obtainable in newborn
TECHNIQUE
■ Use standard sterile technique to place a purse-string suture at base of
umbilicus. Cord is cut with a scalpel 1 cm from the base.
■ The vein is at 12 o’clock and is thin walled with a large lumen. The ura-
chus may persist but can be differentiated from the vein by presence of
urine. The catheter is advanced 1–2 cm beyond the point at which good
blood return is obtained. (See Figure 19.8.)
■ Thetwo arteries have thick walls and smaller lumens. Artery must be
dilated with repeated passes and forceps. Use a 3.5–5 Fr catheter and
advance toward the feet. The tip should be placed anywhere from T6 to
the lower border of the L3 vertebra on X-ray.
COMPLICATIONS
■ Bleeding, infection, vessel perforation
■ Air embolization, especially during catheter removal
■ Thromboembolism, aortic thrombosis, aortic aneurysm, peritoneal perforation
INTERPRETATION OFRESULTS
■ Easy aspiration of blood confirms placement in vein lumen.
■ X-ray of an umbilical vein catheter demonstrates placement in IVC (the
line should go toward the head). An X-ray of an umbilical artery catheter
should show the line going away from the head.
PROCEDURES AND SKILLSIntraosseous access is a
bridge to venous access in
critically ill patients. Once
definitive intravenous access is
obtained, the intraosseous line
should be removed.There is only one umbilical
vein, and that is what you
want to access to provide
treatment to an ill newborn.FIGURE 19.8. Cross section of umbilical cord showing location of vein and arteries.
(Reproduced, with permission, from Tintinalli JE, Kelen GD, Stapczynski JS. Tintinalli’s
Emergency Medicine: A Comprehensive Study Guide, 6th ed. New York: McGraw-Hill, 2004:73.)