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  • • Emergency vascular access for fluid and medications.

    • Administration of high glucose concentration and total parenteral nutrition.

    • Central venous pressure monitoring.

    • Exchange transfusion.

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Absolute

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  • • Omphalitis.

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

    • Necrotizing enterocolitis.

    • Umbilical surgery.

    • 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 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 venous catheterization, very few are seen in practice if adequate precautions are observed.

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

    • Catheters should be removed after 7 days of use to further decrease the chance of infection.

    • 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.

    • Embolization and thrombosis can occur.

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  • • Position the catheter tip away from the origin of hepatic vessels, portal vein, and foramen ovale; the tip should lie in the inferior vena cava just below its junction with the right atrium.

    Never force the catheter past an obstruction.

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

    • Avoid hypertonic infusions when catheter tip is not in the inferior vena cava.

    • Do not leave the catheter open to the atmosphere due to the danger of air embolus.

    • Always confirm catheter position on radiograph before use. The only exception is when an umbilical venous catheter is inserted for resuscitation in the delivery room; in this case a low-lying catheter should be used.

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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 and umbilicus and calculate the length of catheter insertion needed.

    • • ⅔ of shoulder-umbilical cord distance.

      • ½ of UAC line calculation.

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  • • Place the infant in the supine position, and secure the upper and lower extremities (Figure 13–1).

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Figure 13–1.
Graphic Jump Location

Secure extremities and measure shoulder tip to umbilicus.

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  • • In the full-term infant, ...

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