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 urachus 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.)
  • The two 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 OF RESULTS
  •  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.

NOTE:
There is only one umbilical vein, and that is what you want to access to provide treatment to an ill newborn.