Umbilical vein catheterization typically requires no anesthesia.
Before initiating the procedure, a radiant warmer should be obtained, and the patient should be connected to a cardiac monitor. Necessary equipment includes the following:
∙Personal protective equipment (ie, sterile gown, gloves, mask)
∙Sterile drapes
∙Umbilical catheter, 3.5F or 5F
5F umbilical catheter. Note proximal attachment for stopcock.
Clo-up of umbilical catheter.
∙Iris forceps without teeth
∙Small clamps
∙Scalpel
∙Scissors
∙Needle holder
∙Silk suture (3-0) or umbilical tape
∙Intravenous tubing and 3-way stopcock
∙Infusion solution (dextro 5% in water or 0.9% sodium chloride [NaCl] with heparin 1 U/mL solution)
The newborn should be restrained in a supine position and placed beneath a radiant warmer.
∙The umbilical cord stump and surrounding abdomen should be sterilized with a bactericidal solution. Sterile drapes should be placed.
姨妈吧∙ A pur-string suture or umbilical tape is tied around the ba of the stump to provide hemostasis and to anchor the line after the procedure.
∙Using the scalpel, the cord is cut horizontally, approximately 1.5-2 cm from the abdominal wall. Two thick-walled small arteries and one thin-walled larger vein should be identified.
The umbilical vein may continue to ooze blood.
Umbilical stump illustrating arteries and vein.
Illustration of umbilical vein and arteries.
∙Hemostasis is achieved through tightening the umbilical tape or suture. The arteries do not usually bleed condary to vasospasm.
∙Forceps are then ud to clear any thrombi and dilate the vein.
Dilating the umbilical vein and clearing thrombus.
∙ A 3.5F catheter is ud for preterm newborns, and a 5F catheter is ud for full-term newborns.
∙The catheter should be flushed with pre-heparinized solution and attached to a clod stopcock.
∙The catheter is then grasped 1 cm from its distal tip with the iris forceps and gently inrted, aiming the tip toward the right shoulder. Advance the catheter only 1-2 cm beyond the point at which good blood return is obtained. This is approximately 4-5 cm in a full-term neonate. If resistance is initially met, loon the umbilical tape or suture and manipulate the angle of approach.
南池古诗
mac截屏快捷键Inrtion of umbilical vein catheter.
湖南的景点Technique for umbilical vein dilation and inrtion of catheter.
∙Do not force the advancement.
∙Secure the catheter with a suture through the cord, marker tape, and a tape bridge.
∙The position of the catheter must be confirmed radiographically. A properly placed umbilical vein catheter appears to travel cephalad until it pass through the ductus
venosus.
∙Standardized graphs estimate the length of catheter inrtion bad on shoulder-to-umbilicus length. Alternatively, the shoulder-to-umbilicus length may be
multiplied by 0.6 to determine a length that leaves the tip of the catheter above the
diaphragm but below the right atrium.
∙In an emergency resuscitation, the catheter is best advanced only 1-2 cm beyond the point at which good blood return is obtained.
了不起的狐狸爸爸读后感∙When identifying vesls, remember that the vein is usually located in the 12-o’clock position.
∙To ensure an air-free catheter, fill the lumen with infusion solution and clo the stopcock until the catheter is in the vein.
雅思考试时长∙Umbilical vein catheters may be placed in the inferior vena cava above the level of the ductus venosus and below the level of the right atrium (10-12 cm). This acts as central
venous access, allowing central venous pressure (CVP) monitoring, medication infusions, and the administration of hyperalimentation solutions.
∙In an emergency, the catheter is best advanced only 1-2 cm beyond the point at which good blood return is obtained to avoid injecting hyperosmolar fluids into the portal vesls and causing liver necrosis.
∙The catheter may be pulled back, but not advanced, once the sterile field is down.
∙To avoid air embolism as the catheter is removed, tighten the pur-string suture or tape and apply pressure to the umbilicus.阿沙力
∙Intraosous access is another option that can be ud in neonates. Evidence suggests that intraosous access may be obtained more rapidly than umbilical vein access.
∙Infection
∙Hemorrhage
∙Vesl perforation
两边走
∙Creation of a fal luminal tract4
∙Hepatic abscess or necrosis5
∙Air embolism
∙Catheter tip embolism
∙Portal venous thrombosis6
∙Dysrhythmia and pericardial tamponade or perforation (if the catheter is advanced to the heart)7,8,9
Acknowledgments
New York University/Bellevue Hospital Center Departments of E mergency Medicine and P ediatrics
Heather Johnson, MD
The authors and editors of eMedicine gratefully acknowledge the contributions of previous author Linda Regan, MD, to the development and writing of this article.
The authors and editors of eMedicine gratefully acknowledge the assistance of Lars Grimm w ith the literature review and referencing for this arti c le.
