Umbilical Artery Catheter

Aka: Umbilical Artery Catheter, Umbilical Artery Cannula Insertion

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