Umbilical Vein Catheter

Aka: Umbilical Vein Catheter, Catheterization of Umbilical Vein

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II. Background

  1. Umbilical Vein Catheterization functions as a Central Line in newborns
  2. Umbilical vein remains patent for the first week of life (easiest to place the nearer to delivery)
  3. Catheter enters umbilical vein and ultimately enters ductus venosus (near liver) and inferior vena cava

III. Indications: Emergent Access to Newborn Circulation

  1. Exchange Transfusion in Newborns
  2. Acute stabilization
    1. Very ill infants (e.g. Crashing Neonate)
    2. Very low birth weight (<750g)
    3. Congenital Heart Disease

IV. Contraindications

  1. Omphalocele
  2. Omphalitis
  3. Peritonitis
  4. Necrotizing Enterocolitis

V. Preparation

  1. Sterile set-up including drape, gloves, gown, mask
  2. Scalpel (#10 or #15 blade) and Scissors
  3. Iris forceps without teeth, small clamps and needle holder
  4. Intravenous tubing with three way stopcock and flushed Normal Saline
  5. Umbilical Vein Catheter 5 F for term infants (3.5 F for Preterm Infants)
  6. May place a warm compress over a dried umbilical stump to rehydrate it

VI. Technique: Insertion

  1. Performed under sterile conditions
    1. Betadine or Hibiclens preparation of the Umbilicus
    2. Draping of Abdomen
  2. Prepare the Umbilicus
    1. Base of cord tied loosely with umbilical tape (or use a Silk Suture)
    2. Cord cut 1 cm from skin
  3. Prepare the umbilical vein
    1. Hold cord between thumb and index finger
    2. Identify single thin-walled, oval-shaped umbilical vein (12:00) among the two round, smaller umbilical arteries
    3. Remove visible clots from vein with forceps
    4. Insert iris forceps into umbilical vein
    5. Gently dilate umbilical vein with forceps
  4. Insert saline filled 5F (3.5 F if preterm) catheter to proper distance
    1. Do not advance catheter beyond significant resistance
      1. May loosen umbilical tape and retry insertion (but do not force)
      2. Risk of creating a false tract
      3. Avoid too deep of insertion (risk of infusing into liver via ductus venosus)
    2. Emergency Resuscitation (safest method)
      1. Insert catheter 1-2 cm beyond the free flow of blood (4-7 cm total)
      2. Aspirating blood confirms adequate position
    3. Other calculated methods (NICU)
      1. Method 1: Length = 2/3 of Shoulder-Umbilical Cord distance
      2. Method 2: Length = 0.5 x (UAC high line calculation) - 1 cm
  5. Completion
    1. Confirm line placement on XRay (venous catheters with turn superiorly)
      1. Contrast with accidentally cannulating an umbilical artery, which will track inferiorly
    2. Secure line with Suture (purse string) and umbilical tape

VII. Technique: Removal

  1. Purse string Silk Suture around vein
  2. Remove catheter

VIII. Complications

  1. Misplaced catheter (most common)
    1. Portal venous system
    2. Superior mesenteric vein
    3. Left atrium (via foramen ovale)
  2. Other complications
    1. Air Embolism into Portal System (with secondary hepatic necrosis, thrombosis, Portal Hypertension)
    2. Arrhythmia
    3. False lumen
    4. Vessel perforation with Hemorrhage

IX. References

  1. Civitarese and Crane (2016) Crit Dec Emerg Med 30(1): 14-23
  2. Robertson and Shilkofski (2005) Harriet Lane, Mosby, p. 81-6
  3. Warrington (2019) Crit Dec Emerg Med 33(4): 16

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