Paediatrics: Umbilical venous catheter

2021-03-05 12:00 AM

A UVC is indicated in newborns up to 5 days of age for emergency vascular access during resuscitation; vascular access when it is difficult to obtain otherwise; prolonged fluid or drug infusion; exchange transfusion; central venous pressure (CVP) measurement.

Umbilical venous catheter

A UVC is indicated in newborns up to 5 days of age for emergency vascular access during resuscitation; vascular access when it is difficult to obtain otherwise; prolonged fluid or drug infusion; exchange transfusion; central venous pressure (CVP) measurement.

Equipment

  • 5 or 6 Fr umbilical venous catheter.
  • Remaining equipment as for umbilical arterial catheter.

Procedure

  • Measure distance from the umbilicus to mid-sternum (= insertion distance).
  • Catheter insertion should be performed using a strict aseptic technique.
  • Wash hands and put on sterile gloves, gown, +/– surgical mask.
  • Clean and prepare the umbilical stump and create a 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.
  • A flush umbilical catheter with heparinized saline (1Ut/Ml).
  • Secure catheter and ligate unused other umbilical vessels using the method described for the 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, the tip should lie in the inferior vena cava (IVC) just above the diaphragm.
  • The catheter can then be used for blood sampling, fluid or drug administration, or CVP monitoring (the latter only if the catheter tip is above the diaphragm).
  • As soon as the catheter is not needed, remove it slowly and then gently compress the 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 the 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.