|
Umbilical Arterial Catheters |
Umbilical Venous Catheters |
High-lying
UAC |
Low-lying
UAC |
High-lying
UVC |
Low-lying
UVC |
| Catheter Size |
Less than 1kg - 3.5Fr
Over 1kg - 5 Fr |
Less than 1kg - 3.5Fr or 5Fr
Over 1kg - 5 Fr (rarely a catheter as large as 8Fr might be used in larger babies) |
| Position |
Between T6 and T10 (varies amongst institutions); above the superior mesenteric & renal arteries |
Between L3 and L4; above the bifurcation of the mesenteric arteries |
At or a little above the diaphragm; insures placement is not in the liver |
L3 - L4; Generally inserted 2-3cms (until blood return obtained) in emergency situations |
| Ascends to the left of the spine (the side of the heart) |
Ascends to the right of the spine (the side of the liver) |
| Fluid Administration |
Usually 0.5 to 1ml/hr (KVO);
if heparinized usually 0.5 - 1Unit/ml |
Dependant on fluid and nutritional needs of baby |
| Medication Administration |
Not recommended; No consistent practice standards |
Not recommended; No consistent practice standards; Higher incidence of complications than high-lying Medline |
Medications routinely administered; often the site for all compatible, continuous fluids including drips, preferably with another site (i.e. peripheral IV or second lumen) for intermittent meds |
Varies amongst institutions and providers; higher risk of hepatic complications |
| Blood Pressure Monitoring |
Routinely performed |
Routinely performed; waveform tends to dampen more often and earlier |
Not common but can monitor trends in central venous pressure (CVP); neonatal CVP norms not well established |
Not considered reliable |
| Blood Sampling |
Routinely performed |
Can be done but may be determined by provider or institution policy; results more easily affected by solution running through line (i.e. TPN or dextrose); some gtts that may be running can not be interrupted (i.e. dopamine) |
Complications
Many complications are related to position. Correct positioning can help reduce risks. |
Vessel perforation; Thrombosis/Embolism; Infarction; Hemorrhage; Infection; Necrotizing enterocolitis; Perforation of blood vessel, peritoneum or intestines; Hypernatremia; Formation of false tract; Broken or ruptured catheter |
| Aortic thrombus (can cause dampened waveform); Vasospasms (extremities blanch, especially toes; can also affect buttocks and thorax; apply heat to opposite extremity; line may need to be pulled) |
Pericardial effusion/Cardiac tamponade; Arrhythmias (pull line back); Thrombosis & related endocarditis; Haemorrhagic pulmonary infarction; Hydrothorax; Portal hypertension; Extravasation into liver; Hepatic necrosis; Necrotising enterocolitis; 3-16% infection rate |
Rapid pullback and flushing can affect blood flow and pressure to brain
Benefit: Catheter lasts longer |
Higher incidence aortic thrombus and other vascular complications; Thrombosis at renal arteries (L1 - L2) - hypertension, hematuria; Necrotising enterocolitis more likely (catheter tip at or above inferior mesenteric artery, L1 - L3, possible thrombosis); |
Pericardial effusion/Cardiac tamponade (line in atrium or at SVC/right atrial junction), Arrhythmias, Thrombosis, Hemorrhagic pulmonary infarction;, Hydrothorax (line in pulmonary vein) and Portal hypertension more likely; Obstruction of pulmonary venous return in TAPVD; |
Hepatic necrosis, Necrotising enterocolitis, and Perforation of large intestine more likely |
