Chapter 48: Venous Access: Umbilical Vein Catheterization

I. INDICATIONS

1. Immediate, postnatal access for intravenous (IV) fluids or emergency medications.

2. Long-term central venous access in low birthweight (BW) infants or sick infants for administration of IV fluids, total parenteral nutrition, other hypertonic or hyperosmotic solutions, and medications.

3. Exchange or partial exchange transfusion.

4. Delivery of blood and blood products.

5. Central venous pressure monitoring (if umbilical venous catheter [UVC] passes through the ductus venosus).

6. Secondary aid in the diagnosis of cardiovascular or other anomalies by an unusual course of the UVC or the blood gas values are suspicious.

   1. Congenital diaphragmatic hernia. UVC is left of the midline because of the anomalous positioning of the liver in the chest.

   2. Persistent left superior vena cava. UVC extends beyond the lung (it enters the persistent left superior vena cava and then the left jugular vein).

   3. Congenital absence of the ductus venosus. This can cause an abnormal path of UVC (caudal loop is seen on radiograph).

   4. Infracardiac total anomalous pulmonary venous return. Diagnosed by high partial pressure of oxygen in an infradiaphragmatic UVC.

II. EQUIPMENT

1. Basic. Identical to umbilical artery catheterization (see Chapter 28).

2. Umbilical venous catheters

   1. Types. Single lumen: 2.5, 3.5, or 5F; dual lumen: 3.5 or 5F; triple lumen: 5 or 8F.

   2. Size guideline. Preterm: 3.5 or 5F; term and late preterm: 5F. Other guidelines: 3.5 or 5F catheter <3.5 kg, 5 or 8F >3.5 kg. An 8F catheter is recommended for exchange transfusion or large-volume replacement. American Academy of Pediatrics (AAP) Perinatal Continuing Education Program recommendations: 5F for all infants for emergency medications, 8F for exchange transfusions for large infants. Dual (double-lumen) catheters are sometimes recommended in infants <28 weeks and <1000 g, in infants who need several different medications, in infants who need inotropes or insulin, and in critically ill infants such as those with severe cases of persistent pulmonary hypertension or meconium aspiration syndrome.

III. PROCEDURE

1. Important umbilical vein catheter tips

   1. There is only 1 umbilical vein, and it remains a viable option for cannulation up to 1 week after birth. The umbilical vein carries oxygenated blood from the placenta to the fetus. The UVC passes into the umbilical vein through the umbilicus and follows this path: junction of the right and left portal vein in the liver, across the ductus venosus, across the level of the right and left hepatic vein, and into the inferior vena cava (IVC) to the junction of the IVC and right atrium.

   2. In an emergency postnatal situation (eg, delivery room), a UVC can be rapidly inserted until blood return is obtained (usually 2–4 cm in a term infant; some sources insert 5 cm plus cord length with less distance in preterm) as emergency venous access. Resuscitation medications, volume, and blood can be given.

   3. Single- versus multiple-lumen catheters. Cochrane review (2005) makes no recommendation on using single- versus multiple-lumen catheters. Double-lumen catheters decreased the number of additional venous lines ...