Umbilical Catheters: Complete Guide

Umbilical Catheters: Complete Guide for Healthcare Professionals - Types, Procedure & Safety | PediaDevices

Introduction

Umbilical catheters are specialized thin tubes inserted through the umbilical cord stump in newborn babies. These catheters provide direct access to the central blood vessels during the first days of life. They are critical medical devices used in neonatal intensive care units (NICU) for very sick or premature babies who need intensive monitoring and treatment.

The umbilical cord contains three blood vessels: two arteries and one vein. Healthcare professionals can access these vessels within the first 7-14 days after birth, making them a unique and valuable route for medical care in newborns.

Target Users: This guide is designed for healthcare professionals including neonatologists, pediatricians, NICU nurses, nurse practitioners, and medical students involved in neonatal care.

Purpose and Clinical Uses

Umbilical catheters serve several critical purposes in neonatal care:

Primary Functions

Blood Sampling: Frequent blood tests without repeated needle sticks
Blood Pressure Monitoring: Continuous arterial blood pressure measurement
Medication Administration: Delivery of emergency medications and fluids
Nutritional Support: Parenteral nutrition delivery
Blood Gas Analysis: Monitoring oxygen and carbon dioxide levels
Exchange Transfusion: Treatment for severe jaundice or blood disorders

Common Indications

Premature infants requiring intensive care
Respiratory distress requiring ventilation
Birth asphyxia or hypoxic-ischemic encephalopathy
Severe infection or sepsis
Cardiovascular instability or shock
Need for frequent blood sampling
Surgical newborns requiring intensive monitoring

Types of Umbilical Catheters

1. Umbilical Artery Catheter (UAC)

Inserted through one of the two umbilical arteries into the aorta.

Primary Uses:

Continuous blood pressure monitoring
Arterial blood gas sampling
Blood sample collection

Catheter Positions

Position	Location	Vertebral Level
High Position	Above diaphragm	T6-T9
Low Position	Below diaphragm	L3-L4

2. Umbilical Vein Catheter (UVC)

Inserted through the single umbilical vein towards the heart.

Primary Uses:

Emergency vascular access during resuscitation
Central venous pressure monitoring
Intravenous fluid and medication administration
Parenteral nutrition delivery
Exchange transfusion

Optimal Position

The tip should be positioned at the junction of the inferior vena cava and right atrium, or in the inferior vena cava just above the diaphragm.

Catheter Sizes

Baby Weight	UAC Size (French)	UVC Size (French)
Less than 1.2 kg	3.5 Fr	3.5 Fr
1.2 - 3.5 kg	3.5 - 5 Fr	5 Fr
More than 3.5 kg	5 Fr	5 - 8 Fr

Insertion Procedure - Step by Step Guide

Important: Umbilical catheter insertion is a sterile procedure that should only be performed by trained healthcare professionals with proper credentials and experience.

Pre-Procedure Preparation

Step 1: Patient Assessment

Verify indication for catheterization
Obtain informed consent from parents
Check baby's weight and vital signs
Review for contraindications

Step 2: Equipment Preparation

Umbilical catheter of appropriate size
Sterile drapes and gown
Sterile gloves and mask
Antiseptic solution (chlorhexidine or povidone-iodine)
Umbilical tape or cord tie
Scalpel blade
Curved iris forceps (2)
Needle holder
3-0 silk suture
Three-way stopcock
Sterile saline flush

Step 3: Calculate Catheter Length

For UAC:

High position: (3 x birth weight in kg) + 9 cm
Low position: (birth weight in kg) + 7 cm

For UVC:

(0.5 x shoulder-umbilicus distance) + 1 cm
Or approximately: (birth weight in kg x 1.5) + 5.5 cm

Insertion Technique

Step 4: Positioning and Sterile Field

Position baby supine under radiant warmer
Maintain thermoregulation
Perform hand hygiene and don sterile gown and gloves
Clean umbilical area with antiseptic in circular motion
Place sterile drapes leaving umbilicus exposed

Step 5: Cord Preparation

Tie umbilical tape around base of cord (not too tight)
Cut cord horizontally 1-2 cm above skin level with scalpel
Identify vessels: one large thin-walled vein (12 o'clock position) and two smaller thick-walled arteries (4 and 8 o'clock positions)

Step 6: Vessel Cannulation - UAC

Select one umbilical artery (usually the larger one)
Gently dilate artery using curved forceps
Insert catheter with gentle steady pressure
May feel slight resistance at 5 cm due to vessel curve
Advance to predetermined length
Should have easy blood return

Step 7: Vessel Cannulation - UVC

Identify umbilical vein (larger, single vessel)
Gently dilate vein if needed
Insert catheter smoothly to calculated depth
Should have easy blood return with dark venous blood
Do not advance beyond liver (temporary position at 5 cm if unsure)

Step 8: Securing the Catheter

Verify blood return and flush with saline
Secure catheter with purse-string suture or tape bridge
Mark catheter at skin level
Connect to appropriate infusion or monitoring system
Apply sterile dressing

Step 9: Confirmation

Obtain chest and abdominal X-ray immediately
Verify catheter tip position radiographically
Adjust position if needed
Document procedure, catheter length, and position

Care and Maintenance

Daily Care Protocol

Monitor insertion site for bleeding, discharge, or signs of infection
Assess catheter security and position markings
Check catheter patency and blood return
Maintain continuous heparin infusion (0.5-1 unit/ml) in UAC
Monitor distal perfusion: check lower extremities color, temperature, pulses
Record all fluid intake and medications
Maintain strict aseptic technique during access

Infection Prevention

Use sterile technique for all catheter manipulations
Change dressings if soiled or every 7 days
Use closed system for blood sampling
Avoid unnecessary catheter access
Change IV tubing per hospital protocol (typically 96 hours)
Remove catheter as soon as no longer needed

Duration of Use

Catheter Type	Maximum Duration	Notes
UAC	5-7 days	Remove earlier if complications occur
UVC	7-14 days	Can remain longer if centrally positioned and no complications

Complications and Danger Signs

Emergency Signs - Immediate Action Required:

Severe bleeding from insertion site
Blue, pale, or mottled lower extremities
Loss of pulses in legs
Abdominal distension or bloody stools
Air bubbles in catheter line
Sudden cardiovascular instability

Common Complications

Vascular Complications

Complication	Signs	Prevention
Thrombosis	Decreased perfusion, pallor, cyanosis of legs	Heparin infusion, early removal
Vasospasm	Blanching of lower body or legs	Gentle insertion, warming extremities
Hemorrhage	Bleeding from insertion site or loose connections	Secure catheter, check connections frequently
Embolism	Sudden deterioration, stroke symptoms	Avoid air in lines, flush carefully

Infectious Complications

Catheter-associated bloodstream infection (CABSI): Fever, temperature instability, increased support needs
Omphalitis: Redness, swelling, discharge around umbilicus
Peritonitis: Abdominal distension, tenderness

Position-Related Complications

Malposition: Catheter in wrong vessel or incorrect depth
Portal vein thrombosis (UVC): Liver dysfunction
Cardiac arrhythmias (UVC): If tip in heart
Pleural/pericardial effusion: From extravasation

Organ-Specific Complications

Necrotizing enterocolitis: Associated with UAC use
Renal artery thrombosis: Hypertension, hematuria
Hepatic necrosis (UVC): From infusion of hypertonic solutions in liver

Precautions and Safety Measures

Absolute Contraindications

Omphalitis or periumbilical infection
Abdominal wall defects (omphalocele, gastroschisis)
Necrotizing enterocolitis
Peritonitis
Vascular compromise of lower extremities

Relative Contraindications

Umbilical cord stump older than 7-14 days
Coagulation disorders (require correction first)
Previous abdominal surgery

Medication Safety

Via UAC - Avoid:

Hypertonic solutions (greater than 10% dextrose)
Vasopressors if possible (risk of tissue necrosis)
Total parenteral nutrition
Medications known to cause vasospasm

Via UVC - Safe for:

Total parenteral nutrition
Hypertonic solutions
Vasopressors and inotropes
Most IV medications

Monitoring Requirements

Continuous monitoring of lower extremity perfusion
Regular blood pressure monitoring
Daily assessment of catheter function
Monitor for signs of infection
Track all blood sampling volumes
Document input/output accurately

Catheter Removal

Indications for Removal

No longer clinically needed
Maximum duration reached
Any complication develops
Signs of infection
Catheter malfunction or blockage
Vascular compromise

Removal Procedure

Step 1: Preparation

Gather sterile equipment
Ensure baby is stable
Consider alternative vascular access if still needed

Step 2: Removal Technique - UAC

Remove securing sutures or tape
Withdraw catheter slowly over 2-5 minutes
Slow removal reduces vasospasm risk
Apply pressure if bleeding occurs

Step 3: Removal Technique - UVC

Remove securing method
Withdraw catheter steadily but not too fast
Monitor for bleeding
If resistance felt, do not force - may indicate thrombus

Step 4: Post-Removal Care

Inspect catheter tip - should be intact
Send catheter tip for culture if infection suspected
Apply sterile dressing to umbilicus
Monitor site for 24 hours for bleeding or infection
Document procedure and catheter integrity

Frequently Asked Questions

Q1: How long can umbilical catheters stay in place?

UAC can remain for 5-7 days maximum, while UVC can stay for 7-14 days. However, both should be removed as soon as clinically no longer needed to minimize infection risk.

Q2: What is the most common complication?

Catheter-associated infections and thrombosis are the most common complications. Proper sterile technique and early removal when no longer needed help prevent these.

Q3: Can you insert umbilical catheters in older babies?

Insertion becomes progressively difficult after birth. The umbilical vessels usually close within 7-14 days. After this period, other central venous access routes should be considered.

Q4: Why is X-ray confirmation necessary?

X-ray confirms the catheter tip is in the correct position. Malpositioned catheters can cause serious complications including organ damage, thrombosis, or perforation.

Q5: What causes blanching of the legs during UAC insertion?

This indicates vasospasm, a temporary narrowing of blood vessels. It usually resolves by warming the opposite leg or removing the catheter slightly. Persistent blanching requires catheter removal.

Q6: Can both UAC and UVC be used simultaneously?

Yes, when clinically indicated. This allows both arterial monitoring and venous access, but increases infection risk and requires careful monitoring.

Q7: What is the difference between high and low UAC position?

High position (T6-T9) is above the major abdominal vessels and has lower thrombosis rates. Low position (L3-L4) is easier to achieve but may have higher complication rates. Both are acceptable when properly positioned.

Q8: Why use heparin in UAC lines?

Heparin prevents clot formation in the catheter and reduces thrombosis risk in the blood vessels. It is typically used in concentrations of 0.5-1 unit/ml.

Q9: What should be done if blood return is poor?

Check for catheter kinking, position, or clot formation. Do not flush forcefully as this may dislodge a clot. If unable to resolve, consider catheter removal and alternative access.

Q10: Are there alternatives to umbilical catheters?

Yes. Peripheral arterial lines, central venous catheters (PICC lines, femoral lines), and peripheral IV access are alternatives depending on clinical needs.

Storage and Equipment Safety

Catheter Storage

Store in original sterile packaging
Keep in clean, dry environment at room temperature
Check expiration dates before use
Do not use if package is damaged or wet
Maintain inventory rotation (first in, first out)

Equipment Preparation

Prepare sterile procedure cart or tray
Check all equipment before starting procedure
Ensure monitoring equipment is calibrated and functioning
Have emergency equipment readily available
Maintain organized workspace to prevent contamination

Documentation Requirements

Date and time of insertion
Catheter type, size, and lot number
Insertion depth and position
X-ray confirmation of position
Complications during insertion
Daily assessments and interventions
Date and reason for removal

Special Considerations

Extremely Preterm Infants

Use smallest catheter size (3.5 Fr)
Extra care with fragile vessels
More prone to complications
May require lower heparin concentrations
Closer monitoring of perfusion

Infants with Congenital Anomalies

Abdominal wall defects are absolute contraindications
Vascular anomalies may alter vessel anatomy
Cardiac defects require careful UVC positioning to avoid heart
Consider alternative access if anatomy is abnormal

Transport Considerations

When Transporting Baby with Umbilical Catheters:

Ensure catheters are very securely fastened
Have backup IV access if possible
Monitor perfusion during transport
Keep all connections visible and accessible
Bring emergency equipment for catheter complications

Training Requirements

Healthcare professionals performing umbilical catheterization should have:

Formal training in neonatal procedures
Direct supervision until competent
Regular skills maintenance and updates
Knowledge of complications and emergency management
Understanding of unit protocols and policies

Quality and Safety Standards

Institutional Protocols

Every NICU should have written protocols covering:

Indications and contraindications
Insertion procedure standards
Daily care and maintenance
Complication management
Maximum dwell times
Documentation requirements

Infection Control Bundle

Key Elements:

Hand hygiene before and after catheter contact
Maximal sterile barriers during insertion
Chlorhexidine skin antisepsis (if appropriate for gestational age)
Daily assessment of line necessity
Aseptic technique for all line manipulations

Recommended References

For additional information, consult:

American Academy of Pediatrics (AAP) Neonatal Resuscitation Program
Centers for Disease Control (CDC) Guidelines for Prevention of Intravascular Catheter-Related Infections
Cloherty and Stark's Manual of Neonatal Care
Gomella's Neonatology: Management, Procedures, On-Call Problems
Local institutional guidelines and protocols

Medical Disclaimer

Important Notice: This guide is intended for educational and informational purposes only for healthcare professionals. It should not replace clinical judgment, institutional protocols, or formal medical training.

Umbilical catheterization is an invasive procedure with significant risks and should only be performed by qualified healthcare professionals with appropriate training, credentials, and supervision. The information provided here is general in nature and may not apply to every clinical situation.

Always follow your institution's specific protocols, policies, and procedures. Clinical decisions should be based on individual patient assessment, current evidence-based guidelines, and consultation with senior colleagues when appropriate.

This guide does not constitute medical advice. For specific clinical questions or patient care decisions, consult with experienced neonatologists or other qualified medical professionals in your institution.

While every effort has been made to ensure accuracy, medical knowledge and practices evolve continuously. Healthcare providers should stay updated with current literature, guidelines, and best practices in neonatal care.

Liability: The authors and PediaDevices assume no responsibility for any injury, complications, or adverse outcomes that may result from the use of this information. Healthcare professionals using this guide do so at their own professional discretion and responsibility.

Content Reviewed and Verified by Qualified Pediatrician

Last Updated: January 2026

Labels: Neonatal-Care

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