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Umbilical catheters in PICU

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General Points

  1. Umbilical arterial catheters are used for blood gas sampling and blood pressure monitoring. Occasionally they are used for exchange transfusions.
  2. Umbilical venous catheters can be used for resuscitation, otherwise their uses are the same as other central venous lines.
  3. Contraindications include omphalitis, omphalocele, NEC and peritonitis.
  4. Single lumen catheters come in 3.5, 5.0 and 8 Fr x 41 cm. Double lumen catheters come as 5 Fr x 38 cm.
  5. Umbilical catheters are central lines and must be treated accordingly. If there is any suspicion of catheter related infection, vascular insufficiency or Thrombosis they should be removed and not replaced.
  6. Umbilical lines are not a contraindication to enteral feeding.
  7. The Newborn website on the intranet has an excellent guideline on insertion and care of umbilical lines (Newborn Services/Guidelines & Protocols/Clinical Guidelines).

Procedure

  1. Umbilical lines should be inserted under maximal sterile technique.
  2. Measure the distance from shoulder to umbilicus and look at the graph on the newborn site for distance to insert. Alternatively catheter length insertion can be estimated from: UAC distance (cm)=(birth weight (kg)x3)+9 and UVC distance (cm)=(birth weight (kg)x1.5) +5.5
  3. Prime the catheters with normal saline.
  4. Under aseptic technique, examine the umbilical cord to identify the two small tortuous umbilical arteries, which are superiorly placed, and the single umbilical vein, which is inferior.
  5. Dilate the umbilical artery using very fine forceps. When dilated, to a depth of 0.3-0.5 cm, introduce the primed catheter and gently advance. If there is resistance, further dilatation may be required, and the catheter should not be forced. It may be necessary to trim a small amount off the umbilical cord and try again.
  6. The umbilical venous catheter should pass readily without dilatation.
  7. When both are inserted, a purse string suture is placed at the base of the umbilicus and tied to secure the catheters in place, and the catheters labelled to prevent confusion. The catheters should be able to be flushed and blood withdrawn easily.
  8. XR confirmation of placement should be taken prior to use. The umbilical venous catheter ideally sits between T6-9 (high position) or L3-L4 (low position). Catheters sitting at T12-L2 may compromise renal blood flow and should be repositioned. The venous catheter can be distinguished radiographically from the arterial catheter as it descends after the umbilicus before rising to the liver, Whereas the course of the arterial line is straight.
  9. Lines should be secured using "gate strapping" with tape "posts" placed either side of the umbilical stump and a cross piece of tape placed between these,securing a loop of each catheter, a few cm above the umbilical cord.
  10. Removal of Lines: When catheters are no longer required or there are concerns about sepsis, they should be removed slowly (3-5 cm every ten minutes) to allow the vessel to spasm and prevent bleeding.

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Document Control

  • Date last published: 11 February 2011
  • Document type: Clinical Guideline
  • Services responsible: Paediatric Intensive Care Unit
  • Editor: John Beca
  • Review frequency: 2 years