Umbilical Vein Catheterization

Vein wider than artery

Umbilical vein catheterization may be a life-saving procedure in neonates who require vascular
access and resuscitation. The umbilical vein remains patent and viable for cannulation until
approximately 1 week after birth.

Intraosseous access may be obtained more rapidly than umbilical vein access would be.

Indications
The principal indication for umbilical vein catheterization is to gain vascular access during
emergency resuscitation. Alternative uses of the umbilical vein may include exchange
transfusions and central venous access

Contraindications
Absolute contraindications to umbilical vein catheterization include the following:

 Omphalitis

 Peritonitis

 Necrotizing enterocolitis

Equipment
Before the procedure is initiated, a radiant warmer should be obtained, and the patient should be
connected to a cardiac monitor. Necessary equipment includes the following:
 Personal protective equipment (ie, sterile gown, gloves, and mask)
 Sterile drapes
 Umbilical catheter, 3.5 or 5 French (see the images below)
 Iris forceps without teeth
 Small clamps
 Scalpel
 Scissors
 Needle holder
 Silk suture (3-0) or umbilical tape
 IV tubing and three-way stopcock
 Umbilical catheter (5 French). Note
proximal attachment for stopcock and centimeter marking

Patient preparation
The newborn should be restrained in a supine position and placed beneath a radiant warmer.

Technique
 The umbilical cord stump and the surrounding abdomen are sterilized with a bactericidal
solution. Sterile drapes are placed.

 A purse-string suture or umbilical tape is tied around the base of the stump to provide
hemostasis and to anchor the line after the procedure.

 The cord is cut horizontally with the scalpel, approximately 1.5-2 cm from the abdominal
wall. Two thick-walled small arteries and one thin-walled larger vein should be identified.
Vein is usually located in the 12-o’clock position. The umbilical vein may continue to
ooze blood. Hemostasis is achieved by tightening the umbilical tape or suture.

 Forceps are then used to clear any thrombi and dilate the vein

 A 3.5-French catheter is used for preterm newborns, and a 5-French catheter is used for
full-term newborns. The catheter is flushed with preheparinized solution and attached to a
closed stopcock. The stopcock is left closed until the catheter is in the vein.

 The catheter is then grasped 1 cm from its distal tip with the iris forceps and gently
inserted, with the tip aimed toward the right shoulder. The catheter should be advanced
only 1-2 cm beyond the point at which good blood return is obtained; this is
approximately 4-5 cm in a full-term neonate. If resistance is initially met, the umbilical
tape or suture should be loosened and the angle of approach manipulated.

 The catheter is secured with a suture through the cord, marker tape, and a tape bridge.
The position of the catheter must be confirmed radiographically. A properly placed
 umbilical vein catheter appears to travel cephalad until it passes through the ductus
venosus.

Umbilical vein catheters may be placed in the inferior vena cava above the level of the
ductus venosus and below the level of the right atrium (10-12 cm). This acts as central
venous access.

Alternatively, the shoulder-to-umbilicus length may be multiplied by 0.6 to determine a length

that leaves the tip of the catheter above the diaphragm but below the right atrium.

In an emergency, it is best to advance the catheter only 1-2 cm beyond the point at which good
blood return is obtained so as to avoid injecting hyperosmolar fluids into the portal vessels and
causing liver necrosis.

To prevent air embolism as the catheter is removed, tighten the purse-string suture or tape, and
apply pressure to the umbilicus.

Complications
 Infection

 Hemorrhage

 Vessel perforation

 Creation of a false luminal tract

 Hepatic abscess or necrosis

 Air embolism

 Catheter tip embolism

 Portal venous thrombosis

 Dysrhythmia and pericardial tamponade or perforation (if the catheter is advanced to the
heart)