Vascular access in ill neonates who present to the ED can be challenging. Umbilical vein catheterization can be a life-saving option. The umbilical vein remains patent and viable for cannulation until approximately 1 week after birth.
On a sterile field use betadine or chlorhexidine to sterilize the tip of the umbilical cord stump. Tie a 4-0 nylon suture around the cord, approx 1.5 cm from the abdominal wall. Trim the end cord off, horizontally with a scalpel, just distal to the suture. Dilate and de-clot the umbilical vein (there is only one and it’s slightly larger than the two arteries).
Use a 3.5-French catheter for preterm newborns, and a 5-French catheter for full-term newborns.
Gently insert the catheter with the tip aimed toward the right shoulder. Advance 1-2 cm beyond the point at which good blood return is obtained (~4-5 cm in a full-term neonate). If resistance is encountered, loosen the suture. Avid forcing the catheter. If oozing occurs after placement, tighten the suture.
Umbilical stump, with two arteries and one vein visible.
Illustration of umbilical vein and arteries.
Umbilical vein catheterization. Dilating umbilical vein and clearing thrombus.
Umbilical vein catheterization. Insertion of umbilical vein catheter