Umbilical Artery Catheterization

Indications:

Blood gas monitoring in critically ill neonates. Continuous arterial blood pressure monitoring Arterial blood gas sampling Blood sampling for other laboratory tests and studies Infusion of maintenance fluids when other routes are not available Exchange transfusion Angiography

Complications:

Infection Vascular embolus Thrombosis Spasm Vascular perforation Ischemia or necrosis of abdominal viscera Accidental hemorrhage Hypertension air embolus

Caution:
UA catheterization should NEVER be performed if omphalitis or peritonitis is present. It is contraindicated in the presence of possible necrotizing enterocolitis or intestinal hypoperfusion!

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 mesenteric arteries near L1, perhaps decreasing the incidence of thrombosis or ischemia. (2) High line: The tip of the catheter should be above the diaphragm between T6 and T9. A high line may be recommended in infants weighing less than 750 g, in whom a low line could easily slip out.

Catheter Length
Determine the length of catheter required using either a standardized graph or the regression formula. Add length for the height of the umbilical stump (1) Standardized graph: Determine the shoulder-umbilical length by measuring the perpendicular line dropped from the tip of the shoulder to the level of the umbilicus. (2) Birth weight (BW) regression formula: Low line :UA catheter length (cm) = BW (kg) + 7 High line :UA catheter length (cm) = [3 BW (kg)] + 9

Procedure
Determine 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 the procedure. Prepare and drape the umbilical cord and adjacent skin using sterile technique Flush the catheter with a sterile saline solution before insertion. Ensure that there are no air bubbles in the catheter or attached syringe 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 one large, thin-walled umbilical vein and two smaller, thick-walled arteries. Use one tip of open, curved forceps to probe and dilate one artery gently; use both points of closed forceps, and dilate artery by allowing forceps to open gently.

Grasp the catheter 1 cm from its tip with toothless forceps, and insert the catheter into the lumen of the artery. Aim the tip toward the feet, and gently advance the catheter to the desired distance. Do not force. If resistance is encountered, try loosening umbilical tape, applying steady and gentle pressure, or manipulating the angle of the umbilical cord to skin. Often the catheter cannot be advanced because of creation of a false luminal tract. There should be good blood return when the catheter enters the iliac artery

Confirm the position of the catheter tip radiographically. Secure the catheter with a suture through the cord, a marker tape, and a tapebridge. The catheter may be pulled back, but not advanced once the sterile field is broken Observe for complications: Blanching or cyanosis of lower extremities, perforation, thrombosis, embolism, or infection. If any complications occur, the catheter should be removed

Thank you!