Umbilical vein catheterization is a lifesaving procedure in which a radio-opaque catheter is passed through an umbilical vein of a newborn to obtain blood samples, for an exchange transfusion or for emergency administration of drugs, fluids, etc.
Indications
- For exchange blood transfusion
- Rapid replacement of blood or fluids
- Setting up of infusion when other sites fail
- To monitor central venous pressure
- Preferred access in neonates <800 g when peripheral access is difficult
Contraindications
- Infected stump
- Contemplated abdominal surgery
- Omphalitis
- Omphalocele
- Necrotizing enterocolitis
- Peritonitis
Equipment Needed
A sterile tray containing:
- 7-8 Fr size catheter
- 10-mL syringe with heparinized saline
- Sterile slit towels
- Mosquito forceps, antiseptic solution-spirit, Betadine
- Cotton balls in a bowl
- Prescribed fluid
- Kidney tray
- Pair of gloves
- Suture material
Preparation
- Restrain the infant by using a padded crucifix splint for fixing all four limbs.
- The infant should be placed under the radiant warmer in the servo mode to maintain skin temperature around 36.5°C.
- Site should be prepared aseptically using spirit-Betadine-spirit.
- Drape the area using sterile towels.
Procedure for Umbilical Vein catheterization
- Sterilization of cord area and then cutting the cord 2 cm from the skin junction, that is, close to the base of the stump.
- With edge gripped with mosquito forceps, three blood vessels are seen at the base. Two are umbilical arteries with regular outline and thick walls. The umbilical vein has irregular outline and thin collapsed wall.
- After clearing the vein of any clot, etc., the catheter is advanced gently into its lumen for 5-7 cm.
- As soon as the blood begins to flow freely into the catheter, it fills the catheter completely.
- The catheter should be connected to the drip set or the syringe.
- At the end of the procedure, a sterile polyvinyl marker is required to be inserted in the orifice of the umbilical vein.
- It should be tried to facilitate a subsequent catheterization.
Complications
- Infection (sepsis, omphalitis)
- Thrombosis or embolism
- Perforation of vessels or organs
- Malposition (e.g., into the portal vein or hepatic circulation)
- Air embolism if catheter is not fluid-filled during insertion
Nursing Considerations
- Maintain aseptic technique
- Monitor for signs of infection, bleeding, or catheter malfunction
- Document insertion depth, site condition, and infant response
- Ensure catheter is secured and flushed regularly
- Keep the catheter lumen filled with fluid and a closed three-way tap attached to prevent air embolism.
- Insert the catheter gently to avoid vessel perforation or hepatic injury.
- Avoid advancing the catheter into the portal circulation—confirm tip placement at the inferior vena cava above the diaphragm (T8–T9) via X-ray.
- Document catheter length, insertion depth, and tip location.
- Monitor for complications: sepsis, thrombosis, embolism, extravasation, or cardiac tamponade.
- Perform regular site assessments for signs of infection or inflammation.
- Explain the purpose and risks of UVC to parents in clear, compassionate language.
- Encourage parental presence and involvement in non-invasive aspects of care.
REFERENCES
- Annamma Jacob, Rekha, Jhadav Sonali Tarachand: Clinical Nursing Procedures: The Art of Nursing Practice, 5th Edition, March 2023, Jaypee Publishers, ISBN-13: 978-9356961845 ISBN-10: 9356961840
- Omayalachi CON, Manual of Nursing Procedures and Practice, Vol 1, 3 Edition 2023, Published by Wolters Kluwer’s, ISBN: 978-9393553294
- Sandra Nettina, Lippincott Manual of Nursing Practice, 11th Edition, January 2019, Published by Wolters Kluwer’s, ISBN-13:978-9388313285
- Marcia London, Ruth Bindler, Principles of Paediatric Nursing: Caring for Children, 8th Edition, 2023, Pearson Publications, ISBN-13: 9780136859840
- Naveen Bajaj, Rajesh Kumar, Manual of Newborn Nursing, 2nd Edition, 2023, Jaypee Publishers, ISBN:978-9354659294
- Ernstmeyer K, Christman E, editors. Nursing Fundamentals [Internet]. 2nd edition. Eau Claire (WI): Chippewa Valley Technical College; 2024. PART IV, NURSING PROCESS. Available from: https://www.ncbi.nlm.nih.gov/books/NBK610818/
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