Umbilical Artery and Vein Catheterisation

 

Reveiwed by Frank Bloomfield
Updated March 2013
Clinical Guidelines Back Newborn Services Home Page

Umbilical Venous Catheters

Umbilical Artery Catheters

Other Related Documents

References

See also radiology images of UAC and UVC placement

Umbilical Venous Catheters

Anatomy

Position

Duration of use

Catheter size 5

<1500g 3.5F
>1500-3500g 5F

Catheter Choice

For infants who are term or near-term and sick enough to require central access (for example, sepsis, MAS or PPHN), a 5F double-lumen UVC should be inserted.

For infants <1000g, a 3.5F double-lumen catheter should be considered if the infant is likely to need inotropes or multiple infusions.  This will be decided on an individual basis.

Insertion Distance

  • If the shoulder-to-umbilicus distance is measured, the catheter can be inserted the appropriate distance according to the graph (right) 6.
  • Remember to measure from the skin at the base of the stump where it connects to the anterior abdominal wall.
  • Remember to add the length of the umbilical stump to the distance inserted.
  • Another method is to calculate the distance according to the weight of the baby.  See the graph below to evaluate UVC position.
    • An approximation of this is to use the calculation of: UVC length (cm) = (1.5 x birthweight (kg)) + 5.5 5
      or half the UAC length (calculated below) + 1cm 7
Shoulder-umbilicus insertion distance

Complications from UVC insertion include 4

Infection Thromboembolic Catheter Malpostioned in the Heart and Great Vessels Catheter Malpositioned in portal system Other

 

 
  • Pericardial effusion or cardiac tamponade
  • Cardiac arrhythmias
  • Thrombotic endocarditis
  • Haemorrhagic pulmonary infarction
  • Hydrothorax (UVC lodged in or perforating pulmonary vein)
  • Perforation of peritoneum
  • Obstruction of pulmonary venous return (in infants with TAPVD)
  • Plasticizer in tissues
  • Portal hypertension
  • Electrical hazard
    (improper grounding of equipment, or conduction of current through fluid filled catheter).
  • Visceral laceration (hepatic)

Umbilical Artery Catheters

Anatomy

Position

Catheter Size 5

<1200g 3.5F
>1200g 5F
Never use an 8F UAC

Insertion Distance

  • If you know the length of the infant, you can refer to the graph on the right which relates UAC distance to total body length.9
  • This will result in placement at approximately T8.
  • Note that of all the birth measurements, length is the least reliable.
  • Alternatively, the shoulder-to-umbilicus length can be used to estimate catheter insertion distance according to the graph on the right6
    • The average catheter distance is approximately 106% of the shoulder-to-umbilicus distance. A rule-of-thumb is shoulder-to-umbilicus distance + 2 cm allowing for the caveats below
    • Remember to measure from the skin at the base of the stump where it connects to the anterior abdominal wall.
    • Remember to add the length of the umbilical stump to the distance inserted.
Catheter insertion length according to body length
  • Another option - and one which is particularly good if you forget to measure the shoulder-to-umbilicus length - is to calculate the insertion distance using the formula: 

UAC distance (cm) = (birthweight (kg) x4) + 710.  

  • It does no harm to insert the line a centimetre further than calculated, as the line can be pulled back slightly if needed.  However, you should avoid inserting the UAC so far that it needs to be removed from the carotid or subclavian arteries.
UVC and UAC insertion distances by weight

Complications  from umbilical catheterisation include 5

Malpositioned catheter Vascular accident Equipment related Other
  • Vessel perforation
  • Refractory hypoglycaemia
    (if catheter tip opposite coeliac axis)
  • Peritoneal perforation
  • False aneurysm
  • Thrombosis
  • Embolism/Infarction
  • Vasospasm
  • Loss of extremity
  • Hypertension
  • Paraplegia
  • Heart failure (from aortic thrombosis)
  • Air embolism
  • Broken catheter
  • Transection of catheter
  • Plasticizer in tissues
  • Improper grounding of electronic equipment
  • Conduction of current through fluid-filled catheter
  • Haemorrhage
  • Infection
  • Necrotising enterocolitis
  • Intestinal necrosis or perforation
  • Transection of omphalocoele
  • Herniation of appendix through umbilical ring
  • Cotton fibre embolus
  • Wharton-jelly embolus
  • Hypernatraemia

Index of Other Related Documents

References

1 Michel F, Brevaut-Malaty V, Pasquali R, Thomachot L, Vialet R, Hassid S, Nicaise C, Martin C, Panuel M. Comparions of ultrasound and X-ray in determining the position of umbilical venous catheters. Resuscitation 2012; 83: 705-709.
2 Phelps DL, Lachman RS, Leake RD, O W.  J Pediatr 1972; 81(2):336-9
3 Lewis GC, Crapo SA, Williams JG. Critical skills and procedures in emergency medicine. Vascular access skills and procedures. Emergency Medicine Clinics of North America 2013; 31: 59-86.
4 Butler-O’Hara M, D’Angio CT, Hoey H, Stevens TP. An evidence-based catheter bundle alters central venous catheter strategy in newborn infants. Journal of Pediatrics 2012; 160: 972-7
5 Fletcher MA, MacDonald MG, Avery GB. Atlas of procedures in Neonatology. JB Lippincott Co, Philadelphia 1983.
6 Dunn PM. Localisation of the umbilical catheter by post mortem measurement. Archives of Disease in Childhood 1966; 41: 69-75.
7 Shukla H, Ferrara A. Rapid estimation of insertional length of umbilical catheters in newborns. American Journal of Diseases in Childhood 1986; 140: 786-8.
8 Barrington KJ. Umbilical artery catheters in the newborn: effects of position of the catheter tip. Cochrane Database of Systematic Reviews 1999, Issue 1. Art. No.: CD000505. DOI: 10.1002/14651858.CD000505.
9 Rosenfeld W, Estrada R, Jhaveri R, Salazar D, Evans H. Evaluation of graphs for insertion of umbilical artery catheters below the diaphragm. Journal of Pediatrics 1981; 98(4): 627-8.
10 Kumar PP, Kumar CD, Nayak M, Shaikh FAR, Dusa S, Venkatalakshmi A. Umbilical artery catheter insertion length: in quest of a universal formula. Journal of Perinatology 2012; 32: 604-7.