Umbilical Vein Catheterization (UVC)

CPR involves two main components:

• Umbilical vein catheterization involves cannulating the umbilical vein to provide direct vascular access. The procedure should be performed under strict aseptic conditions to reduce the risk of infection.

Preparation and Positioning:

• Place the neonate in a supine position with slight leg elevation.
• Clean the umbilical stump and surrounding area with an antiseptic solution.
• Drape the area with a sterile surgical drape.

Identification of Umbilical Vein:

• Using sterile gloves, identify the umbilical vein, which appears as a thin-walled, larger, and more patent vessel compared to the two thicker-walled umbilical arteries.

Cord Clamping and Cutting:

• Using sterile scissors or a scalpel, cut the umbilical cord about 1-2 cm from the abdominal wall.
• Control bleeding with gentle pressure if needed.

Catheter Insertion:

• Flush the catheter with sterile saline or heparinized saline.
• Gently insert the catheter into the umbilical vein and advance it to the desired length (usually 5-7 cm in low-lying placement or 8-10 cm for high-lying central access).
• If resistance is encountered, withdraw slightly and readjust the angle of insertion.

Confirmation of Placement:

• Aspirate blood to confirm intravascular placement.
• Secure the catheter with sutures or adhesive dressing.
• Obtain an X-ray or ultrasound to confirm proper catheter tip positioning, ensuring it is in the inferior vena cava above the diaphragm but below the right atrium.

Securing the Catheter :

• Once placement is confirmed, the catheter should be secured with sutures or an adhesive dressing to prevent accidental dislodgement.

Post-procedure Care:

• Monitor for signs of infection, bleeding, or malposition.
• Regularly assess catheter patency and function.
• Document the catheter insertion length, placement, and any complications encountered.

While UVC is a valuable procedure, it is associated with potential risks and complications, including:

Early Complications:

• Bleeding – Can occur if the umbilical vein is injured during insertion.
• Infection (Sepsis or Umbilical Catheter- Associated Bloodstream Infection - UCABI) – Due to improper aseptic technique or prolonged catheter use.
• Malpositioning – Incorrect placement can lead to complications such as extravasation, hepatic necrosis, or cardiac arrhythmias.
• Vessel perforation – Can result from excessive force or deep insertion.

Late Complications:

• Thrombosis and Embolism – Due to prolonged catheter use or improper positioning.
• Portal Vein Thrombosis – Can result in long-term hepatic complications.
• Intestinal Necrosis – If medications like hyperosmolar solutions infiltrate surrounding tissues.