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  • • Frequent or continuous measurement of blood gases.

    • Continuous monitoring of arterial blood pressure.

    • Infusion of maintenance glucose-electrolyte solutions.

    • Exchange transfusion.

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Absolute

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  • • Local vascular compromise in lower extremities or buttock area.

    • Omphalitis.

    • Abdominal wall defects (eg, omphalocele, gastroschisis).

    • Necrotizing enterocolitis.

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Relative

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  • • Peritonitis.

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  • • Sterile catheter

    • • Use 3.5F catheter for patients weighing < 1500 g.

      • Use 5F catheter for patients weighing > 1500 g.

    • Sterile umbilical catheter tray includes the following:

    • • Sterile drapes.

      • Povidone-iodine and alcohol swabs.

      • Umbilical tie.

      • Toothed iris forceps.

      • 2 curved non-toothed hemostats.

      • Suture scissors.

      • Small needle holder.

      • 3-0 silk suture on small curved needle.

      • 3-way stopcock with Luer-Lok.

      • 3-mL and 1-mL syringes with needles.

      • 2 × 2 gauze.

      • 4 × 4 gauze.

      • Saline solution with heparin 1 unit/mL.

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  • • Although serious complications have been reported from arterial catheterization, very few are seen in practice if adequate precautions are observed.

    • Bacterial colonization of umbilical arterial catheters has been reported to be as high as 60%; however, bacteremia occurs in less than 5% of infants.

    • • The risk of infection is minimized by placing the catheter under sterile conditions and using a sterile technique for blood sampling from the catheter.

      • Infection risks are low because most infants who require an umbilical arterial catheter are receiving antibiotic therapy for other reasons.

    • Hemorrhage may occur if the catheter inadvertently becomes disconnected or dislodged; however, this is avoided by maintaining exposure of the umbilical site at all times in an isolette or radiant warmer, together with constant nursing supervision.

    • Approximately 5% of catheters decrease circulation to 1 or both legs, especially in infants weighing < 1000 grams.

    • • If this occurs, the catheter should be removed.

      • Circulation usually returns to the extremity within an hour.

    • Embolization and thrombosis can occur.

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  • • Always observe the infant’s face, chest, and lower extremities during catheter placement.

    • Carefully dilate the lumen of the artery before attempting to introduce the catheter.

    • Do not attempt to force the catheter past an obstruction; this may result in vessel perforation requiring surgical intervention and blood volume replacement.

    • Once secured, never advance nonsterile portions of the catheter into the vessel. If the catheter needs to be advanced, it should be replaced.

    • Insertion of an umbilical arterial catheter to a “high” position is associated with fewer complications and is generally preferred.

    • Always confirm catheter position on radiograph before use.

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  • • Place the infant on a radiant warmer.

    • Place chest leads for continuous cardiorespiratory monitoring and a sensor for pulse oximetry monitoring throughout the procedure.

    • Measure the distance from the tip of the shoulder to the umbilicus, and calculate the length of catheter insertion needed (Figure 12–1).

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    • • High line: shoulder to umbilical distance + 2 ...

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