Umbilical Vessel Catheterization

CHAPTER 184 Umbilical Vessel Catheterization

Being able to quickly assess and rapidly intervene in a severely ill infant is essential. Because the umbilical vessels are easily visualized, they are an excellent route for catheterization to provide central vascular access. Whereas umbilical artery catheterization allows for accurate monitoring of central arterial pressure directly through the aorta, umbilical vein catheterization allows for central venous pressure (CVP) monitoring through the inferior vena cava. Umbilical vein catheterization also provides access for rapid infusion of life-sustaining therapies (Fig. 184-1).

Primary care clinicians may need to perform umbilical vessel catheterization in the delivery room for a newborn resuscitation or in the emergency department for a newborn or infant in distress. They may also need to perform it in the nursery or neonatal intensive care unit (NICU) for an infant requiring continuous monitoring or frequent infusions of medications or fluids. In fact, both vessels are frequently catheterized in the NICU for premature infants requiring prolonged vascular access or monitoring.

Compared with the vein, the umbilical artery is a more durable vessel with higher-velocity blood flow; therefore it is easier to visualize and there is a slightly lower risk of complications when it is catheterized. Inserting an umbilical artery catheter (UAC) or an umbilical vein catheter (UVC) is easier if performed in the first 30 to 60 minutes of the infant’s life. However, a UAC may be inserted up to the 7th day of life and a UVC at up to 2 weeks of age. Despite the fact that the vessels are easily accessible, placing a UAC can be a time-consuming procedure and requires skill and experience. Contraindications or difficulty obtaining a UAC insertion may necessitate the need for a UVC for infusions because a UVC insertion is easier to perform. A UVC is also an option if peripheral intravenous access is difficult to obtain, which is likely the case in very premature infants. After the first day of life, there are few data supporting any benefit of a UAC over a UVC for infusion, although an attempt should always be made to obtain peripheral venous access before either of these is inserted, except in infants of very low birth weight.

May 14, 2017 | Posted by in GENERAL & FAMILY MEDICINE | Comments Off on Umbilical Vessel Catheterization

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