Inserting UAC and UVC method , indications complications

1. Neonatal procedures
PART - 1
Dr. Manori Gamage
Senior lecturer
Department of Paediatrics
University of Sri Jayewardenepura

2. Umbilical line insertion
 UAC (Umbilical artery catheterization)
 UVC (Umbilical venous catheterization)
 Most successful during 1st few hours of life.
 Strict sterile procedure.

3. UVC
(Umbilical venous catheterization)
Indications
(a) Emergency venous access
(b) As the main venous access for
IV Fluids/ medications/ TPN
(c) To do exchange transfusion

4. Contraindications
(a) Omphalitis
(b) NEC
Omphalitis

5. How to calculate length
UVC = 1.5 × Weight + 5.5 cm + Stump
Emergency access 5cm with flash back of blood from vessel.

6. Vein Portal vein Vena cava
(Best place for tip of catheter is above liver.)
 Confirm it with radiological investigation.
 T8 - T9 is optimal. Above T 8 Not acceptable.

7. UAC
(Umbilical artery catheterization)
Indications
(a) Prematurity < 27/52
(b) Ventilated baby
(c) Invasive blood pressure monitoring

8. Contraindications
(a) Omphalitis
(b) NEC
(c) IUGR babies with absent or reversal end diastolic flow
(d) Evidence of vascular compromise to lower limbs or buttocks

9. How to calculate length
UAC = 3 × Weight + 9 cm + Stump
or
Diagonally umbilicus to shoulder length + 1cm + Stump

10. Two arteries
Direct downward direction in the abdominal wall
to
Left and right Internal iliac arteries

11. Two arteries with thick wall
Don’t apply excess pressure or don’t handle too much to avoid
formation of false passage.
 UAC - Confirm by pulsation of blood or by an ABG.

12. Venous line Progress cephalic direction to the
right side of the baby.
Arterial line Caudal dip and then goes cephalic
direction
IF
Limb discolouration or reduced perfusion persisting
> 15 min
Line should be removed.

13. UAC
Catheter position in the aorta above the diaphragm
T6 - T9 level or
L3 - L4 level

14. UAC
 Optimal - T6 - T9
 Acceptable - T10 - T11 or L3 - L4
 Not acceptable - T12 - L2 (due to renal and mesentric arteries)

15. Complication of umbilical lines
 Sepsis
 Air/ blood clot embolisation
 Extravasation
 Cardiac tamponade