Umbilical Catheterization
Bailey Freeman, DNP, CRNA and Angela Mordecai
Quick Facts
- Umbilical venous and arterial catheters are commonly placed in neonates for resuscitation, monitoring, and access.
- The umbilical cord contains one vein and two arteries: the vein is thin-walled and larger, while the arteries are muscular and smaller.
- UVC is used for fluid administration and medication; UAC is used for blood pressure monitoring and blood sampling.
- Radiographic confirmation of catheter tip placement is required before use.
Procedure
Indications
- UVC: Emergency access, exchange transfusion, administration of fluids or medications.
- UAC: Continuous blood pressure monitoring, frequent arterial blood gases.
Contraindications
- UVC: Omphalitis or necrotizing enterocolitis (NEC).
- UAC: Coagulopathy, abdominal wall defects, or vascular anomalies.
Equipment and Preparation
- Sterile field: gloves, gown, and drapes.
- Umbilical catheter (3.5–5 Fr depending on weight).
- Umbilical tape or suture, scalpel, forceps.
- Flush syringes, stopcocks, and securement device.
- Pre-calculated drug doses, resuscitation equipment, and radiographic confirmation.
Technique
Umbilical Venous Catheter (UVC)
- Identify the single, large, thin-walled vein in the umbilical stump.
- Insert the catheter gently and advance toward the inferior vena cava (target: just above diaphragm at T8–T9).
- Avoid resistance; withdraw slightly and redirect if needed.
Umbilical Arterial Catheter (UAC)
- Identify one of the two smaller, muscular arteries.
- Advance the catheter initially caudally, then curve it cephalad into the descending aorta.
- Target high (T6–T9) or low (L3–L4) placement confirmed via X-ray.
Confirmation Steps
- Confirm tip location with anteroposterior abdominal radiograph before use.
- UVC tip should be at the IVC–RA junction (T8–T9).
- UAC tip should be high (T6–T9) or low (L3–L4) within the aorta.
Documentation Requirements
- Time, indication, and type of catheter inserted.
- Size and depth of catheter.
- Radiographic confirmation results.
- Complications or resistance during placement.
Scope Guide
Strategies
- Prepare all equipment in advance and use a checklist to minimize delays during placement.
- Clearly identify vein vs artery by size and wall structure before inserting catheter.
- Position neonate supine and secure the umbilical cord stump for visualization and access.
Clinical Optimization
- Measure expected insertion depth before placement using infant’s weight or anatomical landmarks.
- Use a smooth, gentle technique to avoid vessel injury or malpositioning.
- Secure catheter properly to prevent migration or dislodgment during care.
Pearls
- UVCs are preferred for rapid neonatal resuscitation when IV access is unavailable.
- Always confirm tip placement radiographically before use, even if blood returns freely.
- If resistance is encountered, never force advancement—withdraw slightly and redirect.
References
- O’Neill M, Fischer J. Umbilical Vessel Catheterization. In: StatPearls. Treasure Island (FL): StatPearls Publishing; 2023. https://www.ncbi.nlm.nih.gov/books/NBK549869/
- Safer Care Victoria. Umbilical artery catheterisation for neonates. 2022. https://www.safercare.vic.gov.au/best-practice-improvement/clinical-guidance/neonatal/umbilical-artery-catheterisation-for-neonates
- Safer Care Victoria. Umbilical vein catheterisation for neonates. 2022. https://www.safercare.vic.gov.au/best-practice-improvement/clinical-guidance/neonatal/umbilical-vein-catheterisation-for-neonates
