Chapter 12. Umbilical Artery Cannulation

• • Frequent or continuous measurement of blood gases.

  • Continuous monitoring of arterial blood pressure.

  • Infusion of maintenance glucose-electrolyte solutions.

  • Exchange transfusion.

Absolute

• • Local vascular compromise in lower extremities or buttock area.

  • Omphalitis.

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

  • Necrotizing enterocolitis.

Relative

• • 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 and alcohol 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 arterial catheterization, very few are seen in practice if adequate precautions are observed.

  • Bacterial colonization of umbilical arterial catheters has been reported to be as high as 60%; however, bacteremia occurs in less than 5% of infants.

  • • The risk of infection is minimized by placing the catheter under sterile conditions and using a sterile technique for blood sampling from the catheter.

    • Infection risks are low because most infants who require an umbilical arterial catheter are receiving antibiotic therapy for other reasons.

  • 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.

  • Approximately 5% of catheters decrease circulation to 1 or both legs, especially in infants weighing < 1000 grams.

  • • If this occurs, the catheter should be removed.

    • Circulation usually returns to the extremity within an hour.

  • Embolization and thrombosis can occur.

• • Always observe the infant’s face, chest, and lower extremities during catheter placement.

  • Carefully dilate the lumen of the artery before attempting to introduce the catheter.

  • Do not attempt to force the catheter past an obstruction; this may result in vessel perforation requiring surgical intervention and blood volume replacement.

  • Once secured, never advance nonsterile portions of the catheter into the vessel. If the catheter needs to be advanced, it should be replaced.

  • Insertion of an umbilical arterial catheter to a “high” position is associated with fewer complications and is generally preferred.

  • Always confirm catheter position on radiograph before use.

• • 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 to the umbilicus, and calculate the length of catheter insertion needed (Figure 12–1).

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