Umbilical Catheters in Neonatal Care
Umbilical Catheters in Neonatal Care
Umbilical catheters are essential vascular access devices used in neonatal intensive care units (NICUs). They include both umbilical arterial catheters (UAC) and umbilical venous catheters (UVC), providing crucial access for monitoring, medication administration, and fluid management.
Key Points:
- Available for both arterial and venous access
- Typically used in first 5-7 days of life
- Requires strict sterile technique
- Position confirmation vital before use
- Regular monitoring essential
Umbilical Vessel Anatomy
- Umbilical Vein
- Single vessel
- Larger lumen
- Runs from umbilicus to liver
- Connects to portal sinus and ductus venosus
- Umbilical Arteries
- Two vessels
- Smaller lumen
- Branch from internal iliac arteries
- More tortuous course
- Optimal Positions
- UVC: T8-T9 (above diaphragm)
- High UAC: T6-T10
- Low UAC: L3-L4
Catheter Specifications
- Umbilical Venous Catheter (UVC)
- Single or double lumen
- 3.5 Fr - < 1500g
- 5 Fr - > 1500g
- Length markings every centimeter
- Umbilical Arterial Catheter (UAC)
- Single lumen
- 3.5 Fr - < 1500g
- 5 Fr - > 1500g
- End-hole design
Insertion Depth Calculation
- UVC Depth Formulas
- Shoulder-umbilicus length × 0.6 + 1
- Birth weight formula: (3 × birth weight in kg) + 9 cm + 1
- UAC Depth Formulas
- High position: (Birth weight × 3) + 9 cm
- Low position: (Birth weight × 3) + 5 cm
Common Indications
- Umbilical Venous Catheter
- Emergency access in newborn resuscitation
- Central venous access for medications/fluids
- Total parenteral nutrition administration
- Exchange transfusion
- Central venous pressure monitoring
- Umbilical Arterial Catheter
- Continuous blood pressure monitoring
- Frequent blood sampling
- Arterial blood gas analysis
- Infusion of maintenance fluids
- Contraindications
- Absolute
- Omphalitis
- Necrotizing enterocolitis
- Peritonitis
- Relative
- Omphalocele
- Gastroschisis
- Vascular compromised states
- Absolute
Insertion Procedure
- Preparation
- Verify indication and contraindications
- Calculate insertion depth
- Gather equipment
- Ensure proper temperature control
- Sterile Technique
- Full sterile barrier precautions
- Chlorhexidine skin preparation
- Sterile umbilical cord cleaning
- Insertion Steps
- Place umbilical tape for hemostasis
- Fresh cut of cord if needed
- Identify vessels (vein: larger, thin-walled)
- Dilate vessel with dilator if needed
- Insert to calculated depth
- Verify blood return
- Secure catheter
Position Verification
- Radiographic Confirmation
- Chest and abdominal X-ray required
- Lateral view if needed
- Confirm tip position before use
- Optimal Positions
- UVC: Junction of IVC and right atrium
- High UAC: T6-T10 (above diaphragm)
- Low UAC: L3-L4
- Malposition Signs
- Abnormal waveform (UAC)
- Poor blood return
- Resistance to flush
- Vascular compromise
Potential Complications
- Vascular Complications
- Thrombosis
- Vasospasm
- Embolism
- Hemorrhage
- Infectious Complications
- Catheter-related bloodstream infection
- Local infection
- Portal vein thrombosis
- Other Complications
- Pleural/Pericardial effusion
- Cardiac arrhythmias
- Portal hypertension
- Catheter migration
Management & Care
- Daily Assessment
- Site inspection
- Catheter position check
- Blood return verification
- Infection monitoring
- Maintenance Care
- Strict sterile technique for all access
- Regular line flushing
- Dressing changes if needed
- Documentation of assessments
- Duration Guidelines
- UAC: 5-7 days maximum
- UVC: 7-14 days maximum
- Remove if complications develop
- Plan for alternative access
- Removal Protocol
- Slow removal over 5-10 minutes
- Monitor for bleeding
- Apply pressure if needed
- Document removal time and complications
