Equipment

An umbilical catheter insertion tray should be available that includes the following:

Syringe, 1 mL
Syringe, 3 mL (2)
Syringe, 5 mL (2)
Hypodermic needle, 20 gauge
Mosquito hemostat, straight, 5 in. (12.7 cm)
Mosquito hemostat, curved, 5 in. (12.7 cm) (2)
Vessel dilator probe, 5.5 in. (14 cm)
Iris forceps, full curve, 4 in. (10 cm)
Iris forceps, half curve, 4 in. (10 cm)
Iris forceps, straight, 4 in. (10 cm), 1 × 2 teeth
Straight forceps, smooth
Hemostat needle holder, 5 in. (12.7 cm)
Straight Iris scissors
Safety scalpel with No. 11 blade
Silk suture, 4-0, with curved cutting needle
Umbilical tape, 15 in. (38 cm)
Measuring tape
Drape with 6-cm orifice
Gauze pads, 4 × 4 in. (10 × 10 cm) (6)
Gauze pads, 2 × 2 in. (5 × 5 cm) (6)

Additional equipment used in the procedure includes the following:

Single-lumen umbilical artery catheter, 3.5 French (neonate weight < 1500 g) or 5 French (neonate weight >1500 g)
Stopcock, three-way
Additional syringes, 5 mL (2)
Heparinized flush (0.45% sodium chloride plus 1:1 heparin)
Skin preparation solution (4% chlorhexidine gluconate or povidone iodine)
Sterile surgical towels (4)
Surgical mask
Surgical gown
Sterile gloves
Arterial pressure transducer

Anesthesia

Anesthetic agents are not required, because the umbilical cord is devoid of nerve fibers.

Small preterm neonates can be placed in soft arm and leg restraints to prevent movement during the procedure; anesthesia to prevent struggling is not usually required. Full-term and larger preterm neonates can also typically be restrained but may require sedation with intravenous midazolam or fentanyl to decrease struggling.

Positioning

The neonate should be placed in a supine position under a radiant warmer. The head of the neonate should be positioned toward the top of the warmer.

Care must be taken to ensure adequate thermal support during the procedure, especially in neonates with extremely low birth weight.

Technique

Dumpa V, Avulakunta ID. Umbilical Artery Catheterization. Treasure Island, FL: StatPearls; 2020. [Full Text].
Furdon SA, Horgan MJ, Bradshaw WT, Clark DA. Nurses' guide to early detection of umbilical arterial catheter complications in infants. Adv Neonatal Care. 2006 Oct. 6 (5):242-56; quiz 257-60. [QxMD MEDLINE Link].
Rosenfeld W, Estrada R, Jhaveri R, Salazar D, Evans H. Evaluation of graphs for insertion of umbilical artery catheters below the diaphragm. J Pediatr. 1981 Apr. 98 (4):627-8. [QxMD MEDLINE Link].
Shukla H, Ferrara A. Rapid estimation of insertional length of umbilical catheters in newborns. Am J Dis Child. 1986 Aug. 140 (8):786-8. [QxMD MEDLINE Link].
Sritipsukho S, Sritipsukho P. Simple and accurate formula to estimate umbilical arterial catheter length of high placement. J Med Assoc Thai. 2007 Sep. 90 (9):1793-7. [QxMD MEDLINE Link].
Wright IM, Owers M, Wagner M. The umbilical arterial catheter: a formula for improved positioning in the very low birth weight infant. Pediatr Crit Care Med. 2008 Sep. 9 (5):498-501. [QxMD MEDLINE Link].
Min SR, Lee HS. Comparison of Wright's formula and the Dunn method for measuring the umbilical arterial catheter insertion length. Pediatr Neonatol. 2015 Apr. 56 (2):120-5. [QxMD MEDLINE Link].
Gupta AO, Peesay MR, Ramasethu J. Simple measurements to place umbilical catheters using surface anatomy. J Perinatol. 2015 Jul. 35 (7):476-80. [QxMD MEDLINE Link].
Barrington KJ. Umbilical artery catheters in the newborn: effects of position of the catheter tip. Cochrane Database Syst Rev. 2000. CD000505. [QxMD MEDLINE Link].
Lean WL, Dawson JA, Davis PG, Theda C, Thio M. Accuracy of 11 formulae to guide umbilical arterial catheter tip placement in newborn infants. Arch Dis Child Fetal Neonatal Ed. 2018 Jul. 103 (4):F364-F369. [QxMD MEDLINE Link].
Elboraee MS, Toye J, Ye XY, Shah PS, Aziz K, Canadian Neonatal Network Investigators. Association between Umbilical Catheters and Neonatal Outcomes in Extremely Preterm Infants. Am J Perinatol. 2018 Feb. 35 (3):233-241. [QxMD MEDLINE Link].
Seo S. Umbilical artery catheterization. Ramasethu J, Seo S, eds. MacDonald's Atlas of Procedures in Neonatology. 6th ed. Philadelphia: Wolters Kluwer; 2020. 199-216.
Molanus D, van Scherpenzeel M, Derikx J, van den Dungen F. Umbilical artery perforation: a potentially life-threatening complication of umbilical artery catheterisation. BMJ Case Rep. 2017 Nov 14. 2017:[QxMD MEDLINE Link].
Vernooij CM, Hogeman PH, Nikkels PG, Blok CA, Brouwers HA. Necrosis of the left buttock as a complication of umbilical catheterisation in neonatal resuscitation. Arch Dis Child Fetal Neonatal Ed. 2007 Jan. 92 (1):F48. [QxMD MEDLINE Link].
Hwang JH, Chung ML, Lim YJ. Incidence and risk factors of subclinical umbilical catheter-related thrombosis in neonates. Thromb Res. 2020 May 25. 194:21-25. [QxMD MEDLINE Link].
Mitchell RT, Thompson R, Thomas S. Surgical retrieval of a transected umbilical artery catheter. Neonatal Netw. 2007 Mar-Apr. 26 (2):133-4. [QxMD MEDLINE Link].
Inglis GD, Jardine LA, Davies MW. Prophylactic antibiotics to reduce morbidity and mortality in neonates with umbilical artery catheters. Cochrane Database Syst Rev. 2007 Oct 17. CD004697. [QxMD MEDLINE Link].
Sobczak A, Klepacka J, Amrom D, Żak I, Kruczek P, Kwinta P. Umbilical catheters as vectors for generalized bacterial infection in premature infants regardless of antibiotic use. J Med Microbiol. 2019 Sep. 68 (9):1306-1313. [QxMD MEDLINE Link].

Media Gallery

Umbilical artery catheterization. Cleansing of umbilical stump.
Umbilical artery catheterization. Tying of umbilical cord base.
Umbilical artery catheterization. Cutting of umbilical cord.
Umbilical artery catheterization. Identification of umbilical artery.
Umbilical artery catheterization. Dilation of umbilical artery.
Umbilical artery catheterization. Introduction of umbilical artery catheter into vessel.
Umbilical artery catheterization. Aspiration of blood into umbilical artery catheter to verify intraluminal position.
Umbilical artery catheterization. Securing suture in umbilical stump.
Umbilical artery catheterization. Securing suture in umbilical stump looped around umbilical catheter and tied securely in place.
Umbilical artery catheterization. Tape bridge placed to secure umbilical catheters in place.
Umbilical artery catheterization. Correctly positioned umbilical artery catheter with tip at T8-9.
Umbilical artery catheterization. Umbilical artery catheter looped in descending aorta.
Umbilical artery catheterization. Umbilical artery catheter incorrectly positioned in left femoral artery.