Umbilical Vein Catheterisation

Summary
Introduction
Equipment Required
Procedure
Catheter Complications
Catheter Removal

Summary

infants < 800gm should have a UVC as the initial preferred venous access. Preferred catheter tip placement is above the level of the diaphragm

throughout insertion, the catheter must be kept filled with fluid and a closed 3-way tap attached. If the infant takes a deep inspiration negative pressure may be generated and air drawn into the catheter which could result in air embolism
the best location of the catheter tip is in the inferior vena cava above the diaphragm. Placement of the catheter tip in the portal circulation is not acceptable. The position must be checked by X-ray
during an emergency, umbilical venous access is acceptable in the short term as a route for resuscitation drugs and fluids with the catheter tip inserted only 3 - 5cm beyond the muco-cutaneous junction (in this situation the catheter will no thave reached as far as the portal circulation)

Introduction

during the first 7 -10 days of life the umbilical vein is a convenient route for obtaining vascular access during emergencies
when establishing peripheral venous access is technically difficult (it is the initial route of choice for the tiny infant)
as a route for central venous pressure monitoring (in the NICU)

Equipment Required

sterile gloves and gown
instrument pack (as for umbilical artery catheterisation) and sterile drape (transparent plastic is preferred for better patient visualisation)
antiseptic to prepare the skin
umbilical catheter
- multiple lumen catheters are preferable if the infant is <1000g or extremely sick
- a single lumen catheter (FG3.5 < 1000gm, FG5.0 >= 1000gm) is inserted for short term usage. If unavailable, a feeding tube (size 5) could be used
syringe with NaCl 0.9% flush
routine IV line tubing set-up and tape

Procedure

observe standard precautions
consider the use of appropriate measures to relieve distress including
- use or oral sucrose (link to section)
- containing the infant by holding
- securing the catheter as soon as possible
- avoidance of placing clamps or sutures on the skin
place infant on open heated cot
monitor the infant (oximetry and cardiorespiratory) and ensure all four limbs are adequately restrained throughout the procedure
open an atraumatic suture (3 0 silk on cutting edge needle)
if using an infusion, check solution is correct and prepared to the stage where it can immediately run into the catheter
select appropriate catheter, usually 5 Fr. or 3.5 Fr. if infant weighs below 1000 grams
the catheter must be attached to a syringe and filled with infusion solution before insertion
prepare umbilicus, cord and cord clamp with iodine solution, cut the umbilical cord about 1.5 cm from the abdomen, and establish sterile field
insert a purse-string suture near base of Wharton's jelly for haemostasis. Tie a single knot
immobilize cord by two artery forceps at 3 and 9 o'clock, grasping cord edges
insert tip of iris forceps into lumen, allow the forceps to spring open
when blood is in catheter, connect up the two way tap to the infusion and flush catheter gently
tie purse string and tie onto catheter or secure to catheter with tape. Make certain fluid type and rate is specified
label catheter to distinguish from umbilical catheter if present
write out the x-ray request and be sure to inspect the x-ray later
routine heparinization of umbilical venous catheters is not recommended

Catheter Complications

infection
bleeding due to disconnection of tubing. Always use a Luer locked connection when attaching the catheter to infusion lines
perforation - never cut off the rounded end of any indwelling catheter
clot formation, embolism and spasm
effects of catheter malpositioning include cardiac arrhythmias, hepatic necrosis or portal hypertension - avoided by checking catheter positioning by X-ray

Catheter Removal

performed by medical staff
turn infusion off
withdraw catheter gradually as a single procedure
send tip for culture only if infection is suspected
if bleeding occurs press firmly just above the umbilicus
do not nurse the infant in the prone position during removal of the catheter and for the immediate 4 hours after removal

References

Umbilical Vein Catheterisation Protocol, Southern health Care Network -Monash Medical Centre, Newborn Services

Stabilization and Transport of Newborn Infants and At-risk Pregnancies, 4th Edition, 1998,Editors E.D.Bowman, S.M.Levi, A.J.Mclean, F.E.Presbury NETS publication

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