Umbilical Vein Catheterization
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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.
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]
Absolute contraindications for umbilical vein catheterization include the following:
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Murki S, Kumar P. Blood exchange transfusion for infants with severe neonatal hyperbilirubinemia. Semin Perinatol. 2011 Jun. 35(3):175-84. [Medline].
Hoellering AB, Koorts PJ, Cartwright DW, Davies MW. Determination of umbilical venous catheter tip position with radiograph. Pediatr Crit Care Med. 2014 Jan. 15(1):56-61. [Medline].
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Sethi SK, Dewan P, Faridi MM, Aggarwal A, Upreti L. Liver abscess, portal vein thrombosis and cavernoma formation following umbilical vein catherisation in two neonates. Trop Gastroenterol. 2007 Apr-Jun. 28(2):79-80. [Medline].
Costa S, De Carolis MP, Savarese I, Manzoni C, Lacerenza S, Romagnoli C. An unusual complication of umbilical catheterisation. Eur J Pediatr. 2008 Dec. 167 (12):1467-9. [Medline].
Moens E, Dooy JD, Jansens H, Lammens C, Op de Beeck B, Mahieu L. Hepatic abscesses associated with umbilical catheterisation in two neonates. Eur J Pediatr. 2003 Jun. 162(6):406-9. [Medline].
Sakha SH, Rafeey M, Tarzamani MK. Portal venous thrombosis after umbilical vein catheterization. Indian J Gastroenterology. 2007. 26:283-4. [Medline].
Hermansen MC, Hermansen MG. Intravascular catheter complications in the neonatal intensive care unit. Clin Perinatol. 2005 Mar. 32(1):141-56, vii. [Medline].
Onal EE, Saygili A, Koc E, Turkyilmaz C, Okumus N, Atalay Y. Cardiac tamponade in a newborn because of umbilical venous catheterization: is correct position safe?. Paediatr Anaesth. 2004 Nov. 14(11):953-6. [Medline].
Sehgal A, Cook V, Dunn M. Pericardial effusion associated with an appropriately placed umbilical venous catheter. J Perinatol. 2007 May. 27(5):317-9. [Medline].
John P Magnan, MD, MS Attending Physician, Department of Emergency Medicine, Bronx Lebanon Hospital Center; Assistant Professor, Department of Emergency Medicine, Albert Einstein College of Medicine
John P Magnan, MD, MS is a member of the following medical societies: Alpha Omega Alpha
Disclosure: Nothing to disclose.
Mary L Windle, PharmD Adjunct Associate Professor, University of Nebraska Medical Center College of Pharmacy; Editor-in-Chief, Medscape Drug Reference
Disclosure: Nothing to disclose.
Luis M Lovato, MD Associate Clinical Professor, University of California, Los Angeles, David Geffen School of Medicine; Director of Critical Care, Department of Emergency Medicine, Olive View-UCLA Medical Center
Luis M Lovato, MD is a member of the following medical societies: Alpha Omega Alpha, American College of Emergency Physicians, Society for Academic Emergency Medicine
Disclosure: Nothing to disclose.
Vincent Lopez Rowe, MD Professor of Surgery, Program Director, Vascular Surgery Residency, Department of Surgery, Division of Vascular Surgery, Keck School of Medicine of the University of Southern California
Vincent Lopez Rowe, MD is a member of the following medical societies: American College of Surgeons, American Surgical Association, Pacific Coast Surgical Association, Society for Clinical Vascular Surgery, Society for Vascular Surgery, Western Vascular Society
Disclosure: Nothing to disclose.
Linda Regan, MD,
Assistant Director, Emergency Medicine Residency, Co-Director of Undergraduate Education, NYU/Bellevue Department of Emergency Medicine
The authors and editors wish to thank the New York University/Bellevue Hospital Center Departments of Emergency Medicine and Pediatrics and Heather Johnson, MD, as well as Lars Grimm, MD, for his assistance with the literature review and referencing for this article.
Umbilical Vein Catheterization
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