Chapter 23

1. Indications

1. When frequent or continuous measurements of arterial blood gases are required.

1. For continuous arterial blood pressure monitoring.

1. To provide access for exchange transfusion.

1. For angiography.

1. For emergency resuscitation (umbilical vein preferred).

1. Infusion of maintenance solutions (glucose/electrolyte) and/or medications.

2. Equipment. Prepackaged umbilical artery catheterization trays usually include sterile drapes, a tape measure, a needle holder, suture scissors, a hemostat, a forceps, a scalpel, and a blunt needle. Also needed are a three-way stopcock, an umbilical artery catheter (3.5F for an infant weighing <1.2 kg, 5F for an infant weighing >1.2 kg; newer double-lumen catheters are also available to provide an additional access), umbilical tape, silk tape (eg, Dermicel), 3–0 silk suture, gauze pads, antiseptic solution, gloves, a mask and a hat, a 10-mL syringe, 0.5 normal or 0.25 normal saline flush solution (saline with heparin 1–2 units/mL; to decrease thrombotic complications, it is recommended to use a continuous infusion with heparin), and a 22-gauge needle. Calibrated pressure transducer for gauge pressure monitoring.

3. Procedure

1. Place the patient supine. Wrap a diaper around both legs and tape the diaper to the bed. This stabilizes the patient for the procedure and allows observation of the feet for vasospasm.

1. Put on sterile gloves, a mask, a hat, and a sterile gown.

1. Prepare the umbilical catheter tray by attaching the stopcock to the blunt needle and then attaching the catheter to the blunt needle. Fill the 10-mL syringe with flush solution, and inject it through the catheter.

1. Clean the umbilical cord area with antiseptic solution. Place sterile drapes around the umbilicus, leaving the feet and head exposed. Observe the infant closely during the procedure for vasospasm in the legs or signs of distress.

1. Tie a piece of umbilical tape around the base of the umbilical cord tightly enough to minimize blood loss but loosely enough so that the catheter can be passed easily through the vessel (ie, snug but not tight). Cut off the excess umbilical cord with scissors or a scalpel, leaving a 1-cm stump (Figure 23-1A). A scalpel usually makes a cleaner cut, so that the vessels are more easily seen. There are usually two umbilical arteries and one umbilical vein. The arteries are smaller and are usually located at the 4- and 7-o'clock positions. The vein usually has a floppy wall (Figure 23–1B).

1. Using the curved hemostat, grasp the end of the umbilicus to hold it upright and steady.

1. Use the forceps to open and dilate the umbilical artery. First, place one arm of the forceps in the artery, and then use both arms to gently dilate the vessel (Figure 23–1C and D).

1. Once the artery is sufficiently dilated, insert the catheter.

1. Be certain you know the correct length of catheter to be inserted. The catheter is positioned in one of two ways. In "low catheterization," the tip of the catheter lies below the level of L3 or L4. In "high catheterization," the tip lies above the diaphragm at the level of T6-T9. Positioning is usually ...

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