Chapter 13. Umbilical Vein Cannulation

• • 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).

• • In the full-term ...