Umbilical vein Catheter is used for vascular access and resuscitation in neonates. After birth, umbilical vein remains patent and can be cannulated up to 1 week.
Umbilical vein catheter is used when it is not possible to use peripheral access or intraosseous access, which may be preferred.
Indications of Umbilical Vein Catheter
- Vascular access during emergency resuscitation
- Exchange transfusions
- central venous access.
- CVP monitoring
- Medication infusions
- Administration of hyperalimentation solutions.
- Necrotizing enterocolitis
Procedure of Insertion of Umbilical Vein Catheter
An umbilical venous catheter generally passes directly superiorly and remains relatively anterior in the abdomen.
It passes through the umbilicus, umbilical vein, left portal vein, ductus venosus, middle or left hepatic vein, and into the inferior vena cava.
Estimation of Catheter Length
Standardized graphs are available for estimation of the length of catheter insertion on the basis of shoulder-to-umbilicus length.
Alternatively method is to multiply th 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.
No anesthesia is required. The newborn is restrained in a supine position and placed beneath a radiant warmer.
Part is prepared with a bactericidal solution and draped with sterile drapes.
An umbilical vein catheter is prepared. 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 heparinized solution and attached to a closed stopcock. The stopcock is left closed until the catheter is in the vein.
A tape is tied around the base of the stump to provide hemostasis. Some prefer using purse string suture which can be later used to anchor the line after the procedure.
The cord is cut horizontally about 1.5-2 cm from the abdominal wall. There are one umbilical vein and two arteries. Very rarely, there would be one umbilical vein and one artery.
The vein is identifiable by its 12’O clock position and larger lumen.
The vein is dilated with help of forceps and thrombi are removed.
Grasp the catheter 1 cm from its distal tip with the iris forceps and gently inserted, with the tip aimed toward the right shoulder. Initial resistance is initially met may be due to tight umbilical tape or suture. These should be loosened and the catheterization should be tried again with a change in the angle of approach.
The advancement should be gentle and not forced.
In emergency resuscitation, The catheter is to be advanced only 1-2 cm beyond the point at which good blood return is obtained. That means approximately 4-5 cm insertion in a full-term neonate.
For central catheterization in non-resuscitative situations, the tip should go to inferior vena cava just outside of right atrium.
The position of the catheter must be confirmed radiographically in case of central catheter [anteroposterior and lateral chest views, and abdominal radiographs]. Echocardiography can also confirm the position.
If one is passing the catheter to inferior vena cava, difficulty may arise while passing through the ductus venosus.
Following maneuvers may help in negotiation.
- Pull the catheter back to about 4-5cm, then advancing the catheter whilst rotating the catheter clockwise
- Pass another catheter down beside the already mal-placed catheter. The second catheter may be through the ductus venosus.
After the catheter has been inserted, it is secured with a suture to the abdominal wall and the stump.
After Care of Umbilical Catheter
Normally, the catheter is not used beyond 7 days due to increased risk of infection.
If a longer access is required, a PICC If it is anticipated that central venous access is likely to be necessary for longer than 7 days, the UVC should be replaced with a PICC line by 7 days of age.
The catheter may be pulled back, but not advanced, once the sterile field is down.
To prevent air embolism as the catheter is removed, tighten the purse-string suture or tape, and apply pressure to the umbilicus.
- Vessel injury
- False tract
- Hepatic abscess
- Air embolism
- Catheter tip embolism
- Portal venous thrombosis
- Dysrhythmia and pericardial tamponade or perforation
- If the catheter is pushed to the heart
- Murki S, Kumar P. Blood exchange transfusion for infants with severe neonatal hyperbilirubinemia. Semin Perinatol. 2011 Jun. 35(3):175-84.
- Vali P, Fleming SE, Kim JH. Determination of umbilical catheter placement using anatomic landmarks. Neonatology. 2010. 98(4):381-6.
- Kieran EA, Laffan EE, O’Donnell CP. Estimating umbilical catheter insertion depth in newborns using weight or body measurement: a randomised trial. Arch Dis Child Fetal Neonatal Ed. 2016 Jan. 101 (1):F10-5.
- Sakha SH, Rafeey M, Tarzamani MK. Portal venous thrombosis after umbilical vein catheterization. Indian J Gastroenterology. 2007. 26:283-4.