An umbilical catheter is a soft, flexible tube placed into a blood vessel in a newborn’s umbilical stump shortly after birth. This tool is commonly used in neonatal intensive care units (NICUs) for babies who are born prematurely or with medical conditions requiring specialized care. The umbilical cord contains two arteries and one vein, providing a direct route for medical interventions.
Purpose of Umbilical Catheterization
The primary reasons for using an umbilical catheter fall into two distinct categories: monitoring and delivery. The specific vessel used—either an artery or a vein—determines the catheter’s function.
An Umbilical Artery Catheter (UAC) is inserted into one of the two umbilical arteries. Its main function is to allow for continuous blood pressure monitoring and frequent blood sampling without subjecting the infant to repeated needle pricks. This access is useful for checking blood gas levels, like oxygen and carbon dioxide, helping the care team assess respiratory status and adjust breathing support.
An Umbilical Vein Catheter (UVC) is placed into the single, larger umbilical vein. This type of catheter is used to deliver substances directly into the baby’s bloodstream. These can include intravenous (IV) fluids for hydration, total parenteral nutrition (TPN) when feeding by mouth isn’t possible, and medications like antibiotics or drugs to support blood pressure. For very premature infants or those with certain bowel problems, a UVC provides a reliable route for administering treatments.
The Placement Procedure
The insertion of an umbilical catheter is a sterile procedure performed by a trained clinician at the infant’s bedside in the NICU. The area around the umbilical stump is cleaned with an antiseptic solution to minimize the risk of infection. The umbilical cord does not have nerve endings, so the process is not painful for the baby.
After preparing the area, the clinician trims the umbilical stump to clearly identify the umbilical arteries and vein. The catheter is then gently guided into the selected blood vessel to a predetermined depth.
To verify the catheter’s placement, an X-ray is taken. For a UVC, the ideal location for the tip is in the inferior vena cava, just outside the heart, often at the level of the T8-T9 vertebrae. Correct positioning is important to avoid complications related to the heart or liver. Once confirmed, the catheter is secured in place with silk thread and sometimes tape to prevent it from moving.
Potential Complications
While umbilical catheters are valuable, their use has risks that require close monitoring. One of the primary concerns is the potential for infection, as the catheter provides a direct pathway for bacteria to enter the bloodstream.
Another risk is the formation of a blood clot, or thrombosis, along the catheter. A clot can obstruct blood flow through the vessel or break off and travel to other parts of the body, a condition known as an embolism. The care team watches for any signs of compromised circulation, such as changes in skin color or temperature in the legs.
The blood vessel can react to the presence of the catheter. This can lead to a vasospasm, where the vessel temporarily narrows, or other forms of irritation that may affect blood flow to nearby organs like the intestines or kidneys. In rare cases, a mal-positioned catheter could perforate the vessel wall, leading to internal bleeding or fluid leakage. If the catheter becomes dislodged, there is also a risk of bleeding from the umbilical stump.
Catheter Care and Removal
Continuous care is provided to maintain the umbilical catheter and prevent complications. Nursing staff regularly inspect the insertion site for any signs of redness, swelling, or discharge that might indicate an infection. They also ensure the catheter remains securely fastened to prevent it from being accidentally dislodged. All medications and fluids are administered through sterile tubing connected to the catheter.
The need for the catheter is reassessed daily. The catheter is removed once the infant’s condition has stabilized, and they can breathe and feed normally. The removal process is straightforward and painless for the infant.
To remove the catheter, any securing stitches are cut, and the tube is gently and slowly withdrawn. After the catheter is out, a healthcare provider applies firm pressure to the umbilical stump with sterile gauze for several minutes to prevent any bleeding. The area is left uncovered for easy observation to ensure bleeding has stopped.