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Unique to the neonate, lifesaving central access can be achieved through catheterization of the umbilical vessels. Umbilical artery catheterization can routinely be performed in newborns up to 24 hours old and occasionally in those up to 1 week old. Umbilical vein catheterization is feasible up to 2 weeks of age.1
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Indications for central access include volume expansion, blood transfusion, infusion of resuscitative medications, administration of hypertonic solutions including parenteral nutrition, and frequent laboratory draws. Peripheral access should be attempted first but should not delay central access in a critically ill infant.
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Arterial catheters are indicated in newborns requiring frequent arterial blood gases and/or invasive blood pressure monitoring. An umbilical artery catheter has the advantage of rapid insertion and may also be used to deliver fluids, medications, and blood products.
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Overlying soft tissue infection (e.g. omphalitis), peritonitis, possible necrotizing enterocolitis, and abdominal anomalies (e.g. omphalocele) are contraindications to placing an umbilical vessel catheter.2 Umbilical lines should not be placed in infants greater than 2 weeks of age and should be avoided in patients with known thrombotic disease. Finally, one must remember that these are central lines and are not placed for routine blood sampling or administration of fluids or medications.
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Radiant warmer with light source
Cardiorespiratory monitor
Pulse oximeter
Measuring tape
Surgical mask with face shield, surgical cap
D5W, D10W, or 0.45% NaCl infusion setup with heparin 1 unit/mL (unless medications are incompatible with heparin)
Soft infant restraints
Adhesive tape
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Povidone–iodine solution
Sterile drapes, gauze, gloves, gown
Scalpel (number 11 or 15)
Curved hemostats (2)
Straight forceps
3-0 silk suture
Needle driver
Scissors
Umbilical tape
Umbilical catheters (3.5, 5, or 8 French with end hole)
Three-way stopcock
Curved, toothless forceps or pointed, solid metal dilator
10-mL syringe filled with sterile normal saline (with heparin 1 unit/mL if available)
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Arrange the materials and warmer before the patient’s arrival, if feasible. Address any cardiorespiratory issues before the procedure. Determine the length of the catheter. Venous catheter placement can be estimated by measuring the shoulder to umbilicus length in centimeters and multiplying by 0.6 (Figure 193-1). For arterial catheter placement, an estimated length can be calculated using the formula (birth weight (kg) × 3) + 9 cm. Recent data suggest that the Wright formula (birth weight (kg) × 4) + 7 cm is a more accurate estimate, especially in very low birth-weight infants, but may result in under-insertion of the catheter.3,4...