Umbilical Venous Catheterization

Umbilical venous catheterization procedure

Umbilical Venous Catheterization (UVC) is a typical neonatal procedure, an umbilical access of the central vein in the newborns, usually employed in the neonatal intensive care unit (NICU). It enables the administration of fluids, drug, parenteral nutrition, and blood sampling in patients with a critical illness among the neonates.

Indications

• IV fluid, parenteral nutrition, or drugs.
• Exchange transfusion
• Central venous pressure surveillance.
• Blood (in ill newborns) sampling.
• Newborn resuscitation emergency access.

Contraindications

• Omphalitis (umbilical stump infection)
• Peritonitis
• Necrotizing enterocolitis (NEC)
• Inborn defect of the umbilical vein or portal system.
• Umbilical venous thrombosis.

Equipment Required

• Sterile gloves, gown, drapes
• Antiseptic solution (povidone-iodine or chlorhexidine)
• Umbilical venous catheter (3.5 Fr in case of preterm and 5 Fr in case of term newborns)
• Scalpel or scissors
• Umbilical tie or suture
• Syringes, saline flush, 3-way stopcock.
• Sterile dressing and adhesive dressing are sterile gauze and adhesive dressing.
• Measuring tape or ruler

Preparation

• Placing the infant: On his back under a radiant warmer.
• Stabilize umbilical stem: Wipe the site with antiseptic and lay sterile covers.

Identify the vessels:

• Umbilical vein: There is a single, huge, thin-walled vessel (at 12 o’clock position).
• Umbilical arteries: Two smaller vessels (one at 4 and one at 8 o’clock) are thick-walled.

Step-by-Step Procedure

• Wash and rinse the catheter using sterile saline.
• Umbilical cut at 1-2cm off the skin.
• Find and enlarge umbilical vein with a sterile forceps.
• Placing the catheter: This should be done very carefully in the umbilical vein:
• Grasp gradually until blood is easily distilled.
• Keep going to the predestined length (tip preferably at IVCRA junction).
• Check blood return and clear saline to maintain patency.
• Tie the catheter with an umbilical tie or purse-string.
• Use sterile dressing on the stump.
• Confirm the location with X- ray/ ultrasound:
• The tip must be at T8 vertebrae -T9 (IVC-RA junction).

Post-Procedural Care

• Watch bleeding, catheter patency and infection.
• Keep the line aseptic.
• Frequently check catheter position (particularly following repositioning the baby).
• Take out catheter when it is not needed any longer (almost always in 7-10 days).

Complications of umbilical venous catheterization

Umbilical venous catheterization is an essential neonatal practice, although it is associated with a number of possible complications that may be acute or delayed, local or systemic as per the site of catheter insertion, sterility, and catheter stay.

Immediate Complications

Malposition of catheter

• Instead of IVCRA junction, tip goes into portal vein, liver, parenchyma or heart.    

Umbilical stump bleeding

• Damage to vessel wall during insertion or cryoskeleton fixation.

Air embolism

• Air that came in as either flushing or insertion.    

Vessel perforation

• Violent push or malplacement of catheter.    

Arrhythmias

• Tip tried to enter the right atria or the ventricles.    

Delayed Complications

Infection (Sepsis, Omphalitis)

• Because of bad asepsis or long-term (>7 days) catheter.    

Thrombosis / Embolism

• The development of thrombus at the tip of the catheter or catheter vessel injury.    

Hepatic necrosis / Parenchymal injury

• Portal vein infused with catheter tip in hepatic parenchyma.    

Portal vein thrombosis

• As a result of long-standing catheterization or malpositioning.    

Pericardial effusion Cardiac tamponade

• Right atria perforation and leakage due to catheter tip.    

Catheter blockage

• Formation of clot or infusion of incompatible solutions.    

Extravasation of fluids

• External infusion as a result of displacement.    

Catheter fragment embolization

• Catheter breakage during removal/handling.    

Long-term portal hypertension

• Secondary to portal vein thrombus or injury to the liver.    

Delayed or Prolonged Complications

• Hepatic abscess
• Biliary tract obstruction
• Recurrent portal hypertension.
• Venous stenosis or fibrosis

Umbilical venous catheter insertion risks

Umbilical venous catheterization is a common practice among the neonatal unit, but it has a number of risks associated with it. Such risks are typically associated with the mechanical complications, infection, thrombosis, or the improper position.

Mechanical Risks

Catheter malposition

• Too brief or too profound; tip in portal vein, liver, or heart.    

Vessel perforation

• Rudely developing or weak neonatal vessels.    

Arrhythmias

• Touch of myocardium in right atria/ventricles.    

Air embolism

• Air injected during insertion or flushing.    

Catheter fracture or movement

• Catheter material, manipulation, weak.    

Infectious Risks

Umbilical stump infection (Omphalitis)

• Contamination during handle or insertion.    

Sepsis

• The colonization of catheter or ill aseptic technique.    

Thrombotic Risks

Thrombosis

• Vessel wall injury or long stay catheterization.    

Embolism

• Loose clot or fragment of catheter.    

Hepatic & Infusional Risks

Hepatic necrosis

• Portal vein catheter tip and hyperosmolar infusion.    

Extravasation

• Out of vessel infusion as a result of displacement.    

Portal high blood pressure (long-term)

• Portal circulation thrombosis or scarring.

Umbilical venous catheter insertion recovery

Umbilical venous catheterization is considered to be a rather safe technique and the recovery and monitoring are the main aspects of this operation to make sure the neonate is in good condition and without complications. As compared to surgical insertions, UVC does not demand long-lasting healing although careful observation is necessary.

Immediate Post-Insertion Care 

• Keep track of vital signs: heartbeat rate, breathing, blood pressure, oxygen concentration.
• Check catheter patency: flush with saline to ascertain free flow.
• Notice of the site of insertion bleeding, redness, or swelling of the umbilical stump.
• Check catheter location: X-ray or ultrasound must show the tip of IVC to right atrial junction.

Ongoing Monitoring

• Umbilical stump and skin inspection are performed daily.
• Determine infection signs: redness, lethargy, discharge, fever.

Observation of mechanical complications:

• Catheter migration
• Thrombosis (search limb swelling, hepatomegaly)
• Abdominal/scrotal edema (extravasation of fluids).
• Blood studies when necessary: to detect an indication of sepsis or liver damage.

Duration of Catheter Use

• Normally 7-10 days with some exceptions of up to 14 days.
• Prolonged use exposes one to infection and thrombosis.
• Take off the catheter when there is other IV access.

Removal and Post-Removal Care

• Easy withdrawal process: slowly pull out catheter, put pressure, and cover stump with sterile dressing.
• Watch bleeding: none or minimal.
• Watch delayed complications: infection, thrombosis, or extravasation.
• Umbilical stump normally carries out on its own within few days after removal of the catheter.

Conclusion

Umbilical venous catheter is an important and frequently utilized surgery in the neonatal unit, which places central venous access to fluids, medications, parenteral nutrition, and emergency procedures in ill or preterm babies. UVC is a safe and effective technique of neonatal central venous access, when done properly and closely supervise. The knowledge of possible risks and the care of great caution after insertion are the two keys to the best results of the newborns.

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FAQ

What is an umbilical venous catheter (UVC)?

• A UVC is a thin, flexible tube that is inserted into the umbilical vein of a newborn to offer central venous access to the fluids, medications, parenteral nutrition, and blood sampling.

What is the duration of stay of a UVC?

• Usually 7–10 days. With prolonged use, there is an intensification of risk of infection and thrombosis.

How is catheter placement confirmed?

• By X-ray or ultrasound. The most ideal tip site is at IVC- right atrial junction (T8-T9 spinal cord level).

How is a UVC removed?

• It is easy and fast to remove: the catheter can be gently pulled out, pressure applied to the stump and sterile dressing should be applied. The umbilical stump normally heals on its own.