• Emergency vascular access for fluid and medications.
• Administration of high glucose concentration and total parenteral
• Central venous pressure monitoring.
• Exchange transfusion.
• Abdominal wall defects (eg, omphalocele, gastroschisis).
• Necrotizing enterocolitis.
• Umbilical surgery.
• 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.
• 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
• 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
• Avoid hypertonic infusions when catheter tip is not in the inferior
• 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.
• 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.
Secure extremities and measure shoulder tip to umbilicus.
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