Background
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 (IV) 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.
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 would be.
Indications
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. [2] The use of umbilical vein catheterization through Wharton's jelly to deliver medications in the delivery room has been described. [3] An umbilical approach may be useful for cardiac catheterization in small neonates. [4]
Contraindications
Absolute contraindications for umbilical vein catheterization include the following:
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Umbilical vein catheterization. Technique for umbilical vein dilation and insertion of catheter.
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Illustration of umbilical vein and arteries.
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Umbilical catheter (5 French). Note proximal attachment for stopcock.
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Close-up of umbilical catheter.
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Umbilical vein catheterization. Dilating umbilical vein and clearing thrombus.
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Umbilical vein catheterization. Insertion of umbilical vein catheter.
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Umbilical stump, with two arteries and one vein visible.