Umbilical Artery Catheterization

What is Umbilical Artery Catheterization? 

Umbilical artery catheterization is a medical operation where a catheter (thin and flexible tube) is inserted through one of umbilical arteries of the newborn. It is mainly applied to neonatal intensive care units (NICU) to:

• Measure blood pressure on a regular basis.
• Get regular blood samples without using a needle repeatedly.
• Give drugs or intravenous fluids to severely ill newborn babies.

Indications

The catheterization of Umbilical artery is usually ordered in:

• Preterm or the sick neonates that are in need of vital observation.
• Neonates who are suffering respiratory distress syndrome.
• Infants who require regular blood gas tests in the arteries.
• Infants who need observation of their hemodynamic condition or intravenous administration of drugs (e.g., vasoactive drugs)

Procedure

Preparation:

• Strict sterility is required.
• Infant is lying on his back.
• Antiseptic cleansed umbilical stump.

Steps:

• Umbilical cord is cut and clamped.
• To insert the catheter a small incision can be made in the cord.
• One of the two umbilical arteries is replaced by a soft catheter (usually 3.5-5 Fr in the case of neonates).

The catheter is preceded to the right level:

• High position: T6-T10 (thoracic aorta) to measure the blood pressure properly.
• Low position: L3-L5 (lumbar aorta) to access blood and blood sample easier.
• Catheter position is established through X-ray.
• The catheter is fixated and monitoring of complications is done.

Umbilical artery catheterization success rate

Umbilical artery catheterization (UAC) success is determined by a number of factors such as the experience of the clinician, size and gestational age of the newborn, and type of catheter. Here’s a detailed breakdown:

Success Rate

Initial insertion success:

• The majority of the studies show success rates of 80-95 per cent on first or second attempt in term and near-term infants.
• Catheterization: The catheterization procedure is successful.
• With the addition of repositioning or repeated attempts, success rates are approximately 95-99%.

Factors affecting success:

Gestational age and birth weight:

• Very low birth weight (<1000 g) or very premature babies (<28 weeks) have marginally poor success rates because they have weak vessels and are small.

Catheter size:

• Success and complication reduction are enhanced with the use of a catheter of the correct size.

Clinician experience:

• Professionally trained NICU staff members enjoy greater first-attempt success.

Umbilical cord condition:

• Damaged or short cords may result in difficulty in insertion.

Factors Affecting Umbilical artery catheterization cost in India

Unilateral artery catheterization (UAC) cost in India depends on different factors, such as the type of hospital, geographic location, the gestational age of the offspring, and complications. Here's a detailed breakdown:

Hospital Type and Location

• Private Hospitals: NICU is higher in cities such as Bangalore, and it varies according to the insurance and the condition of the infant. 
• Tier-2 Cities: Cities such as Guwahati may be low cost, but may lack specialized care.

Gestational Age and Birth Weight

• Infants with Preterm and Low Birth Weights: Preterm and low weight babies tend to spend more time in NICU, which raises their overall treatment costs.
• Research Studies have shown that families with babies who weigh between 500-999 grams could be lesser in costs. 

Procedure-Related Factors

• Catheter Type: Umbilical venous and arterial catheters may be chosen depending on the cost.
• Ultrasound Guidance: More effective but may add costs to the cost of equipment and trained personnel to use ultrasound in the placement of catheters. 

Associated Complications

• Infection and Thrombosis: Infections and Thrombosis can result in prolonged hospital stays and further treatment, which are both very costly.

Best hospitals for umbilical artery catheterization in India

• Artemis Hospital, Gurgaon
• Medanta-The Medicity, Gurgaon
• Fortis Memorial Research Institute, Gurgaon
• Max Hospital, Saket

Conclusion

Umbilical artery catheterization is a vital practice within the neonatal intensive care unit, where it is possible to constantly measure blood pressure and take frequent blood samples with ease in critically ill newborns. The success is high- 80 to 95% on first attempt and 95 to 99% overall but varies based on factors such as gestational age, birth weight, catheter size and experience of clinicians.

Umbilical artery catheterization in India with GetWellGo

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FAQ

1. How long can the catheter remain in place?

• Normally, 5-14 days basing on the condition and likelihood of complications of the neonate. It should be removed early when it is not in use.

2. Who performs UAC?

• The procedure is most often carried out under sterile conditions by either neonatologists or trained NICU nurses/physicians.

3. What are some alternatives of UAC?

• Peripheral arterial blood pressure lines.
• Several venous blood tests.

These options can however be less safe or more painful to the neonate.