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Clinical Procedures > Vascular Techniques
Catheterization, Umbilical Vein
Article Last Updated: Aug 18, 2008
AUTHOR AND EDITOR INFORMATION
Section 1 of 13  
Author: John P Magnan, MD, MS, Attending, Department of Emergency Medicine, Bronx Lebanon Hospital Center
John P Magnan is a member of the following medical societies: Alpha Omega Alpha, American College of Emergency Physicians, and American Medical Association
Editors: Andrew K Chang, MD, Associate Professor, Department of Emergency Medicine, Albert Einstein College of Medicine, Montefiore Medical Center; Mary L Windle, PharmD, Adjunct Assistant Professor, University of Nebraska Medical Center College of Pharmacy, Pharmacy Editor, eMedicine; Luis M Lovato, MD, Associate Clinical Professor, David Geffen School of Medicine at UCLA; Director of Critical Care, Department of Emergency Medicine, Olive View/UCLA Medical Center; Gil Z Shlamovitz, MD, Assistant Professor of Emergency Medicine, University of Connecticut School of Medicine; Attending Physician, Emergency Department, Windham Community Memorial Hospital, Willimantic, CT; Attending Physician, Emergency Department, Hartford Hospital, Hartford, CT; Rick Kulkarni, MD, Medical Director, Assistant Professor of Surgery, Section of Emergency Medicine, Yale-New Haven Hospital
Author and Editor Disclosure
Synonyms and related keywords:
umbilical vein catheterization, UV cath, infusion catheter, umbilical vein line, vascular access in neonates, neonatal vascular access, preterm UV, full-term UV, UV catheterization, infant vascular access, vascular infusion, infant vascular infusion
Umbilical vein catheterization may be a life-saving procedure in neonates who require vascular access and resuscitation. The umbilical vein remains patent and viable for cannulation until approximately 1 week after birth. After proper placement of the umbilical line, intravenous fluids and medication may be administered to critically ill neonates.1
When critically ill newborns present to the emergency department, peripheral access is preferred. If this is impossible, umbilical vein catheterization may be attempted.
For a pediatric case requiring emergent umbilical vein access, see the Medscape CME article A Newborn Presenting in Extremis.
- The principal indication for umbilical vein catheterization is to gain vascular access during emergency resuscitation.
- Alternative uses of the umbilical vein may include exchange transfusions and central venous access.
Absolute contraindications to umbilical vein catheterization include the following:
Umbilical vein catheterization typically requires no anesthesia.
Before initiating the procedure, a radiant warmer should be obtained, and the patient should be connected to a cardiac monitor. Necessary equipment includes the following:
- Personal protective equipment (ie, sterile gown, gloves, mask)
- Sterile drapes
- Umbilical catheter, 3.5F or 5F
5F umbilical catheter. Note proximal attachment for stopcock.
Close-up of umbilical catheter. - Iris forceps without teeth
- Small clamps
- Scalpel
- Scissors
- Needle holder
- Silk suture (3-0) or umbilical tape
- Intravenous tubing and 3-way stopcock
- Infusion solution (dextrose 5% in water or 0.9% sodium chloride [NaCl] with heparin 1 U/mL solution)
The newborn should be restrained in a supine position and placed beneath a radiant warmer.
- The umbilical cord stump and surrounding abdomen should be sterilized with a bactericidal solution. Sterile drapes should be placed.
- A purse-string suture or umbilical tape is tied around the base of the stump to provide hemostasis and to anchor the line after the procedure.
- Using the scalpel, the cord is cut horizontally, approximately 1.5-2 cm from the abdominal wall. Two thick-walled small arteries and one thin-walled larger vein should be identified. The umbilical vein may continue to ooze blood.
Umbilical stump illustrating arteries and vein.
Illustration of umbilical vein and arteries. - Hemostasis is achieved through tightening the umbilical tape or suture. The arteries do not usually bleed secondary to vasospasm.
- Forceps are then used to clear any thrombi and dilate the vein.
Dilating the umbilical vein and clearing thrombus. - A 3.5F catheter is used for preterm newborns, and a 5F catheter is used for full-term newborns.
- The catheter should be flushed with pre-heparinized solution and attached to a closed stopcock.
- The catheter is then grasped 1 cm from its distal tip with the iris forceps and gently inserted, aiming the tip toward the right shoulder. Advance the catheter only 1-2 cm beyond the point at which good blood return is obtained. This is approximately 4-5 cm in a full-term neonate. If resistance is initially met, loosen the umbilical tape or suture and manipulate the angle of approach.
Insertion of umbilical vein catheter.
Technique for umbilical vein dilation and insertion of catheter.
- Do not force the advancement.
- Secure the catheter with a suture through the cord, marker tape, and a tape bridge.
- The position of the catheter must be confirmed radiographically. A properly placed umbilical vein catheter appears to travel cephalad until it passes through the ductus venosus.
- Standardized graphs estimate the length of catheter insertion based on shoulder-to-umbilicus length. Alternatively, the shoulder-to-umbilicus length may be multiplied by 0.6 to determine a length that leaves the tip of the catheter above the diaphragm but below the right atrium.
- In an emergency resuscitation, the catheter is best advanced only 1-2 cm beyond the point at which good blood return is obtained.
- When identifying vessels, remember that the vein is usually located in the 12-o’clock position.
- To ensure an air-free catheter, fill the lumen with infusion solution and close the stopcock until the catheter is in the vein.
- Umbilical vein catheters may be placed in the inferior vena cava above the level of the ductus venosus and below the level of the right atrium (10-12 cm). This acts as central venous access, allowing central venous pressure (CVP) monitoring, medication infusions, and the administration of hyperalimentation solutions.
- In an emergency, the catheter is best advanced only 1-2 cm beyond the point at which good blood return is obtained to avoid injecting hyperosmolar fluids into the portal vessels and causing liver necrosis.
- The catheter may be pulled back, but not advanced, once the sterile field is down.
- To avoid air embolism as the catheter is removed, tighten the purse-string suture or tape and apply pressure to the umbilicus.
- Intraosseous access is another option that can be used in neonates. Evidence suggests that intraosseous access may be obtained more rapidly than umbilical vein access.
Complications of umbilical vein catheterization include the following:2, 3
- Infection
- Hemorrhage
- Vessel perforation
- Creation of a false luminal tract4
- Hepatic abscess or necrosis5
- Air embolism
- Catheter tip embolism
- Portal venous thrombosis6
- Dysrhythmia and pericardial tamponade or perforation (if the catheter is advanced to the heart)7, 8, 9
New York University/Bellevue Hospital Center Departments of Emergency Medicine and Pediatrics
Heather Johnson, MD
The authors and editors of eMedicine gratefully acknowledge the contributions of previous author Linda Regan, MD, to the development and writing of this article.
The authors and editors of eMedicine gratefully acknowledge the assistance of Lars Grimm with the literature review and referencing for this article.
| Media file 1:
Technique for umbilical vein dilation and insertion of catheter. |
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| Media file 2:
Illustration of umbilical vein and arteries. |
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| Media file 3:
5F umbilical catheter. Note proximal attachment for stopcock. |
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| Media file 5:
Dilating the umbilical vein and clearing thrombus. |
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| Media file 7:
Umbilical stump illustrating arteries and vein. |
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- Butler-O'Hara M, Buzzard CJ, Reubens L, McDermott MP, DiGrazio W, D'Angio CT. A randomized trial comparing long-term and short-term use of umbilical venous catheters in premature infants with birth weights of less than 1251 grams. Pediatrics. Jul 2006;118(1):e25-35. [Medline].
- O'Gorman CS. Insertion of umbilical arterial and venous catheters. Ir Med J. May 2005;98(5):151-3. [Medline].
- Sethi SK, Dewan P, Faridi MM, Aggarwal A, Upreti L. Liver abscess, portal vein thrombosis and cavernoma formation following umbilical vein catherisation in two neonates. Trop Gastroenterol. Apr-Jun 2007;28(2):79-80. [Medline].
- Costa S, De Carolis MP, Savarese I, Manzoni C, Lacerenza S, Romagnoli C. An unusual complication of umbilical catheterisation. Eur J Pediatr. Mar 18 2008;[Medline].
- Moens E, Dooy JD, Jansens H, Lammens C, Op de Beeck B, Mahieu L. Hepatic abscesses associated with umbilical catheterisation in two neonates. Eur J Pediatr. Jun 2003;162(6):406-9. [Medline].
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- Onal EE, Saygili A, Koc E, Turkyilmaz C, Okumus N, Atalay Y. Cardiac tamponade in a newborn because of umbilical venous catheterization: is correct position safe?. Paediatr Anaesth. Nov 2004;14(11):953-6. [Medline].
- Sehgal A, Cook V, Dunn M. Pericardial effusion associated with an appropriately placed umbilical venous catheter. J Perinatol. May 2007;27(5):317-9. [Medline].
- Fuchs, Susan et al. APLS - The Pediatric Emergency Medicine Resource. Fourth Revis ed. Jones & Bartlett Publishers, Incorporated; 2006.
- Roberts JR, Hedges JR. Pediatric vascular access and blood sampling techniques. In: Clinical Procedures in Emergency Medicine. 4th. Philadelphia, PA: WB Saunders Company; 2004:375-6.
- Robertson J, Shilkovski N. Procedures. In: Robertson J. The Harriet Lane Handbook: A Manual for Pediatric House Officers. 17th. Philadelphia, PA: Elsevier Science; 2005:81-6.
- Kattwinkel J. Textbook of Neonatal Resuscitation. 4th. Elk Grove Village, IL: American Academy of Pediatrics; 2000.
Catheterization, Umbilical Vein excerpt Article Last Updated: Aug 18, 2008
Topic originally published: Jun 29, 2007
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