Umbilical artery catheterization (UAC) is a standard-of-care (commonly performed) procedure in neonatal intensive care units for arterial access in neonates.
UAC is relatively easy to perform, but it is challenging and requires a highly skilled technique and thorough practice of catheterizing.
Before the procedure is initiated, the insertion depth of the catheter is determined based on the neonate’s height and weight.
- The catheter is passed through the umbilicus of the neonate, from where it travels inferiorly through the umbilical artery to an anterior division of the internal iliac artery, then into the common iliac artery, and finally reaches the aorta.
- It is extremely necessary to ensure that the tip of the catheter is in the aorta itself and not in a branch of the aorta because being there it can block the vessel or instill a highly concentrated solution directly into an organ vessel, such as the renal artery.
The tip of the catheter can be placed in two locations based on the thoracic and lumbar vertebrae levels:
- High position: At T6 to T10 level
- The insertion depth can be calculated by using the following formulas:
- Shukla formula:
- Umbilical artery catheter depth (cm) = (birth weight [kg] × 3) + 9
- Wright formula:
- Umbilical artery catheter depth (cm) = (birth weight [kg] × 4) + 7
- Gupta formula: Used more often in low-birth-weight infants
- (UN – 1 cm) + 2USp
- UN is the distance from the umbilicus to the nipple, and USp is the distance from the umbilicus to the symphysis pubis.
- (UN – 1 cm) + 2USp
- Shukla formula:
- The insertion depth can be calculated by using the following formulas:
- Low position: At L3 to L5 level
- The high position is preferred due to a low incidence of vascular complications and without an increase in adverse sequelae.
- The desired position is ensured by an X-ray. Once the catheter is in the right position, it is held up in a place with a thread or taped to the belly area of the newborn.
What is the purpose of UAC?
The umbilical cord consists of two arteries and a vein to carry the blood back and forth between the mother and fetus.
An umbilical line consists of a catheter that is inserted in any of the two arteries or veins of the umbilical cord.
When the catheter is inserted into the artery, it is known as umbilical artery catheterization (UAC), and when it is inserted into the vein, it is known as umbilical vein catheterization.
UAC is preferred in extremely premature or critically ill neonates because it provides quick access to the central circulation for continuous blood pressure monitoring, frequent measurement of arterial blood gases, and blood sampling.
What is an umbilical artery catheter used for?
When a newborn is ill right after birth, an umbilical catheter (long, soft, and hollow tube) is primarily indicated in the following conditions:
- Continuous arterial blood pressure monitoring
- Infusion of fluids for maintenance purposes (parenteral nutrition) when other routes are inaccessible
- Strong medications are required to control blood pressure in a neonate
- Blood sampling for laboratory tests
- Blood sampling for measuring arterial blood gases
- Exchange transfusion
- Angiography
How long can umbilical artery catheters stay in?
The umbilical artery is used for arterial access during the first five to seven days of life, whereas it is rarely used beyond 7 to 10 days.
Umbilical artery catheterization is contraindicated in the following conditions:
- Cord anomalies
- Peritonitis (inflammation of the peritoneum or covering of the abdominal wall)
- Omphalocele (a birth defect of the abdominal wall)
- Omphalitis (an infection of the umbilical stump)
- Necrotizing enterocolitis (a serious intestinal disease in premature infants)
What are the risks of umbilical catheters?
Umbilical artery catheterization may cause complications such as:
- Blood-borne catheter-related infection (sepsis)
- Air embolism
- Thromboembolic complications
- Heart tamponade
- Heart rhythm disorders (cardiac arrhythmias)
- Substantial blood loss
- Vascular compromise (interrupted blood flow) to the kidneys, buttocks, or lower limbs
- Hepatic necrosis
- Portal hypertension
SLIDESHOW
Conception: The Amazing Journey from Egg to Embryo See SlideshowHealth Solutions From Our Sponsors
Medically Reviewed on 3/18/2022
References
Image Source: iStock Images
Taylor Sawyer Umbilical Artery Catheterization WebMD: https://emedicine.medscape.com/article/1348931-overview#a1
Umbilical Artery Catheterization NIH: https://www.ncbi.nlm.nih.gov/books/NBK559111/
Taylor Sawyer Umbilical Artery Catheterization WebMD: https://emedicine.medscape.com/article/1348931-overview#a1
Umbilical Artery Catheterization NIH: https://www.ncbi.nlm.nih.gov/books/NBK559111/
Complete List
Top How Do You Place an Umbilical Artery Catheter Related Articles
How Common Are Complications During Childbirth?
Labor or childbirth is a physiologic process during which the fetus, membranes, umbilical cord and placenta are expelled from the uterus. The most common complications during childbirth include preeclampsia, eclampsia, gestational diabetes, preterm labor, infections and uterine atony.
How Do I Know If I Can Have a Vaginal Birth?
Some C-sections are medically necessary and can't be avoided. However, there are some things you can do to reduce your chances of needing a C-section if this is your first pregnancy.
How Do You Treat and Repair an Umbilical Hernia?
Hernias develop when an internal part of the body pushes through a weak point of muscle or tissue. Learn what medical treatments can help your umbilical hernia and ease your symptoms.
How Long Can Umbilical Venous Catheters Be Used?
A medical professional may use an umbilical venous catheter (UVC) to monitor blood pressure, draw blood, or administer medications or IV fluids to a newborn baby. UVC catheters do not cause pain for a baby.
How Long Does It Take for the Umbilical Cord to Fall Off?
The cord will normally fall off 1-3 weeks after birth. The average cord falls off between 10 and 14 days with 21 days being the higher side of normal.
Is Natural Birth Better Than Epidural?
You might feel pressured to have a natural birth or an epidural, but the fact is that one isn’t necessarily better than the other.
Labor and Delivery
Early and later symptoms and signs of labor and delivery are unique to each woman. Early signs of labor are "lightning" and passing the mucus plug. Later symptoms and signs that labor that labor is are the woman's water breaking, and when contractions begin. There are three stages of labor, stage 1 is the longest and occurs when the cervix begins to thin and dilate. During stage 2 of labor the baby passes through the birth canal and remains there until delivery, and stage 3, is when the baby is delivered.
Pregnancy: Multiple Births, Twins, Triplets, and More
Multiple births occur when a woman bears twins, triplets, or even more babies during pregnancy. More multiples are born today thanks to assisted reproductive technology (ART), including in vitro fertilization using fertility drugs. Women carrying multiples often give birth via C-section.What Is the Recovery Time for An Umbilical Hernia Surgery?
An umbilical hernia repair is a relatively routine surgery and takes about 20 to 30 minutes. It can be performed as an open surgery or a minimally invasive laparoscopic surgery. An open surgery might require two to three days of hospitalization, but with a laparoscopic surgery a patient may be able to go home the same day or after 24 hours.
What Are the Risks of Natural Birth After C-Section?
Is a natural or vaginal birth after cesarean (VBAC) an option for you? Learn about the possible risks and factors that may affect your decision.What Causes an Umbilical Hernia?
What is an umbilical hernia and how are they caused? Learn more about umbilical hernias, how umbilical hernias happen, and what to expect if you or your baby has an umbilical hernia.
What Does Labor and Giving Birth Feel Like?
There are three stages of labor you'll progress through during and after a vaginal delivery.
What Is an Umbilical Hernia Repair Surgery?
A hernia is a protrusion of an internal body part, such as the intestine, through a weak spot in the muscle or the surrounding tissue wall. An umbilical hernia repair is a corrective surgery for a hernia in the navel (umbilicus) region.What Is the Most Common Complication of Childbirth?
The most common complication of childbirth is labor that does not progress. Learn about other childbirth complications and what can be done about them.
Why Is an Umbilical Arterial Catheter Used?
An umbilical artery catheter (UAC) is a long, soft tube that medical professionals put in a newborn's umbilical artery. The UAC lets doctors perform an exchange transfusion or angiography, check the baby's blood pressure, or collect blood samples.