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Umbilical Artery Catheterization

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Indications:Blood gas monitoring in critically ill neonates.Continuous arterial blood pressure monitoringArterial blood gas sampling

Blood sampling for other laboratory tests and studies

Infusion of maintenance fluids when other routes arenot available

Exchange transfusionAngiography

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Complications:

Infection

Vascular embolus

Thrombosis

Spasm

Vascular perforation

Ischemia or necrosis of abdominalviscera

Accidental hemorrhage

Hypertension

air embolus

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Caution:UA catheterization should NEVER beperformed if omphalitis orperitonitis is present. It iscontraindicated in the presence of

possible necrotizing enterocolitis orintestinal hypoperfusion!

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Arterial Line

Low vs High(1) Low line: The tip of the catheter should lie

just above the aortic bifurcation between L3

and L5. This avoids renal and mesentericarteries near L1, perhaps decreasing theincidence of thrombosis or ischemia.

(2) High line: The tip of the catheter should be

above the diaphragm between T6 and T9. A highline may be recommended in infants weighingless than 750 g, in whom a low line couldeasily slip out.

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Catheter LengthDetermine the length of catheterrequired using either a standardizedgraph or the regression formula.

Add length for the height of theumbilical stump

(1) Standardized graph: Determinethe shoulder-umbilical length bymeasuring the perpendicular linedropped from the tip of the shoulderto the level of the umbilicus.

(2) Birth weight (BW) regressionformula:

Low line :UA catheter length (cm) =BW (kg) + 7

High line :UA catheter length (cm) =[3 BW (kg)] + 9

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ProcedureDetermine the length of the catheter to be inserted for either high

(T6 to T9) or low (L3 to L5) position

Restrain the infant. Maintain the infants temperature during theprocedure. Prepare and drape the umbilical cord and adjacentskin using sterile technique

Flush the catheter with a sterile saline solution before insertion.Ensure that there are no air bubbles in the catheter or attachedsyringe

Place sterile umbilical tape around the base of the cord. Cut

through the cord horizontally about 1.5 to 2.0 cm from the skin;tighten the umbilical tape to prevent bleedinge. Identify the onelarge, thin-walled umbilical vein and two smaller, thick-walledarteries. Use one tip of open, curved forceps to probe and dilateone artery gently; use both points of closed forceps, and dilateartery by allowing forceps to open gently.

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Grasp the catheter 1 cm from its tipwith toothless forceps, and insert thecatheter into the lumen of the

artery. Aim the tip toward the feet,and gently advance the catheter tothe desired distance. Do not force.

If resistance is encountered, tryloosening umbilical tape, applyingsteady and gentle pressure, ormanipulating the angle of theumbilical cord to skin.

Often the catheter cannot beadvanced because of creation of afalse luminal tract.

There should be good blood returnwhen the catheter enters the iliacartery

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Confirm the position of the catheter tip

radiographically. Secure the catheter with asuture through the cord, a marker tape, anda tapebridge. The catheter may be pulledback, but not advanced once the sterile field

is broken

Observe for complications: Blanching orcyanosis of lower extremities, perforation,

thrombosis, embolism, or infection. If anycomplications occur, the catheter should beremoved

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Thank you!