• Frequent or continuous measurement of blood gases.
• Continuous monitoring of arterial blood pressure.
• Infusion of maintenance glucose-electrolyte solutions.
• Exchange transfusion.
• Local vascular compromise in lower extremities
or buttock area.
• Abdominal wall defects (eg, omphalocele, gastroschisis).
• Necrotizing enterocolitis.
• 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.
• 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
• 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.
• 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
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