Umbilical Artery Catheterization Periprocedural Care

Updated: Feb 24, 2017
  • Author: Taylor L Sawyer, DO, MEd, FAAP, FACOP; Chief Editor: Vincent Lopez Rowe, MD  more...
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Periprocedural Care

Equipment

An umbilical catheter insertion tray should be available that includes the following:

  • Syringe, 1 mL
  • Syringe, 3 mL (2)
  • Syringe, 5 mL (2)
  • Hypodermic needle, 20 gauge
  • Mosquito hemostat, straight, 5 in.
  • Mosquito hemostat, curved, 5 in. (2)
  • Vessel dilator probe, 5.5 in.
  • Iris forceps, full curve, 4 in.
  • Iris forceps, half curve, 4 in.
  • Iris forceps, straight, 4 in., 1 × 2 teeth
  • Straight forceps, smooth
  • Hemostat needle holder, 5 in.
  • Straight Iris scissors
  • Safety scalpel with No. 11 blade
  • Silk suture, 4-0, with curved cutting needle
  • Umbilical tape, 15 in.
  • Measuring tape
  • Drape with 6-cm orifice
  • Gauze pads, 4 × 4 in. (6)
  • Gauze pads, 2 × 2 in. (6)

Additional equipment used in the procedure includes the following:

  • Single-lumen umbilical artery catheter, 3.5 French (neonate weight <1500 g) or 5 French (neonate weight >1500 g)
  • Stopcock, three-way
  • Additional 5-mL syringes (2)
  • Heparinized flush (0.45% sodium chloride plus 1:1 heparin)
  • Skin preparation solution (4% chlorhexidine gluconate or povidone iodine)
  • Sterile surgical towels (4)
  • Surgical mask
  • Surgical gown
  • Sterile gloves
  • Arterial pressure transducer
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Patient Preparation

Anesthesia

Anesthetic agents are not required, because the umbilical cord is devoid of nerve fibers.

Small preterm neonates can be placed in soft arm and leg restraints to prevent movement during the procedure; anesthesia to prevent struggling is not usually required. Full-term and larger preterm neonates can also typically be restrained but may require sedation with intravenous midazolam or fentanyl to decrease struggling.

Positioning

The neonate should be placed in a supine position under a radiant warmer. The head of the neonate should be positioned toward the top of the warmer.

Care must be taken to ensure adequate thermal support during the procedure, especially in neonates with extremely low birth weight.

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