II. Indications
- Infant at high risk of death from primary condition
- Extreme prematurity (Birth weight < 1000 grams)
- Hyaline Membrane Disease
- Persistent Pulmonary Hypertension
- Severe Aspiration Pneumonia
- Shock
III. Uses
- Central IV Access
- Monitoring of Blood Gasses
- Withdrawing blood samples
IV. Complications
- Infection
- Thromboembolism
V. Materials
- Saline filled umbilical catheter
- Weight >1250 gram Infant: 5 French
- Weight <1250 gram Infant: 3.5 French
- Infusion solution containing 0.5-1.0 U Heparin/ml
VI. Techniques
- Performed under sterile conditions
- Prepare Umbilical Cord
- Base of cord tied
- Cord cut 1 cm from skin
- Hold cord between thumb and index finger
- Insert iris forceps into umbilical artery
- Gently dilate umbilical artery with forceps
- Insert saline filled catheter to proper distance
- Low Line (at L3-L4, above aortic bifurcation)
- Standard positioning for most infants weighing >750 g
- Avoid placing line below diaphragm but above L3! (risk of mesenteric and renal artery injury)
- Length = BirthWtKg + 7 cm
- High Line (Above diaphragm: T6-T10)
- Indicated in very Low Birth Weight Infants (<750 g) in whom catheter may dislodge out
- Method 1: Length = Shoulder-Umbilicus distance + 2 cm
- Method 2: Length = (3 x BirthWtKg) + 9 cm
- Low Line (at L3-L4, above aortic bifurcation)
- Confirmation
- Confirm line placement on XRay
- Secure line with Suture and tape
VII. Precautions
- Remove UAC as soon as possible!
VIII. References
- Robertson and Shilkofski (2005) Harriet Lane, Mosby, p. 81-6