Chapter 13

• • Emergency vascular access for fluid and medications.

• Administration of high glucose concentration and total parenteral nutrition.

• Central venous pressure monitoring.

• Exchange transfusion.

### Absolute

• • Omphalitis.

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

• Necrotizing enterocolitis.

• Umbilical surgery.

• Peritonitis.

• • 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.

• • 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 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.

• • 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.

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

###### Figure 13–1.

Secure extremities and measure shoulder tip to umbilicus.

• • In the full-term infant, ...

Sign in to your MyAccess profile while you are actively authenticated on this site via your institution (you will be able to verify this by looking at the top right corner of the screen - if you see your institution's name, you are authenticated). Once logged in to your MyAccess profile, you will be able to access your institution's subscription for 90 days from any location. You must be logged in while authenticated at least once every 90 days to maintain this remote access.

Ok

## Subscription Options

### AccessPediatrics Full Site: One-Year Subscription

Connect to the full suite of AccessPediatrics content and resources including 20+ textbooks such as Rudolph’s Pediatrics and The Pediatric Practice series, high-quality procedural videos, images, and animations, interactive board review, an integrated pediatric drug database, and more.