Umbilical venous catheter
A UVC is indicated in newborns up
to 5 days of age for: emergency vascu-lar access during resuscitation; vascular
access when it is difficult to obtain otherwise; prolonged fluid or drug
infusion; exchange transfusion; central venous pressure (CVP) measurement.
•
5 or 6
Fr umbilical venous catheter.
•
Remaining
equipment as for umbilical arterial catheter.
•
Measure
distance from umbilicus to mid-sternum (= insertion distance).
•
Catheter
insertion should be performed using strict aseptic technique.
•
Wash
hands and put on sterile gloves, gown, +/– surgical mask.
•
Clean
and prepare umbilical stump and create sterile field.
•
Identify
umbilical vein and then dilate opening with fine forceps or a dilating probe.
•
Insert
catheter the measured distance (see Procedure, first bullet point).
•
Aspirate
blood to confirm insertion. Blood from the umbilical vein should not pulsate and, when the catheter hub is held open
to the air above the infant, blood will slowly fall back to the infant. Do not
do this for long or an air embolus will result!
•
If
blood will not aspirate or resistance is felt before the catheter is inserted
the measured distance, it is likely that the catheter tip has lodged in the
hepatic portal veins or sinus. Withdraw the catheter and then reinsert as far
as it will go while still allowing blood aspiration.
•
Flush
umbilical catheter with heparinized saline (1Ut/Ml).
•
Secure
catheter and ligate unused other umbilical vessels using method described for umbilical
arterial catheter.
•
Remove
cord ligature and check for bleeding.
•
Confirm
correct position by a combined CXR/AXR. UVC should only follow a direct course
proximally through the liver (unlike a UAC) Ideally, tip should lie in the
inferior vena cava (IVC) just above diaphragm.
•
The
catheter can then be used for blood sampling, fluid or drug administration, or
CVP monitoring (the later only if the catheter tip is above the diaphragm).
•
As
soon as the catheter is not needed, remove it slowly and then gently compress
umbilical stump until bleeding stops.
•
In an
emergency (e.g. resuscitation at birth) the procedure is simplified. Simply,
cut the umbilical cord with a scalpel blade 1–2cm distal to the umbilical skin
and rapidly insert the umbilical catheter until blood can be aspirated.
Resuscitation drugs and fluids can then be given safely. Don’t worry about
haemorrhage as cardiac output will be minimal or absent in such an emergency!
Besides, any bleeding can be easily controlled by squeezing the base of the
umbilicus between the thumb and index finger. Note: Caution is needed as air embolism will occur if an umbilical
catheter is left open to the air for any significant time.
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