Emergency Medicine Book

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Umbilical Artery Catheter

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  1. 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
  2. Uses
    1. Central IV Access
    2. Monitoring of Blood Gasses
    3. Withdrawing blood samples
  3. Complications
    1. Infection
    2. Thromboembolism
  4. 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
  5. Techniques
    1. Performed under sterile conditions
    2. Betadine prep of Umbilicus
    3. Draping of abdomen
    4. Base of cord tied
    5. Cord cut 1 cm from skin
    6. Hold cord between thumb and index finger
    7. Insert iris forceps into umbilical artery
    8. Gently dilate umbilical artery with forceps
    9. Insert saline filled catheter to proper distance
      1. High Line (Above diaphragm: T6-T10)
        1. Method 1: Shoulder-Umbilicus distance + 2 cm
        2. Method 2: 3 x Birth weight (kg) + 9 cm
      2. Low Line (at L3-L4)
      3. Avoid placing line below diaphragm but above L3!
    10. Confirm line placement on XRay
    11. Secure line with Suture and tape
  6. Precautions
    1. Remove UAC as soon as possible!

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