Umbilical Vein Catheterization

  • 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.
  • Peripheral access obtainable in newborn
  • 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.
  • Bleeding, infection, vessel perforation
  • Air embolization, especially during catheter removal
  • Thromboembolism, aortic thrombosis, aortic aneurysm, peritoneal perforation
  •  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.

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