1. Immobilize the patient. Measure the distance between the umbilicus and the right shoulder.

2. Clean the umbilical stump and surrounding area with iodine solution. Drape the umbilical area, but leave the head and feet uncovered.

3. Tie the base of the cord with the umbilical tape to minimize blood loss.

4. Cut the cord cleanly across its length to 1 cm with the scalpel. The arteries are small and have pinpoint openings. The vein is larger and has thinner walls and a larger opening.

5. Grasp the edge of the cord with the forceps. Using the iris forceps, enlarge the opening of the umbilical artery first with the tip of one arm of the forceps.

6. Insert both arms of the forceps to dilate the artery so that it will accept the catheter.

7. The length of the catheter inserted for the low position is two-thirds of the distance from the umbilicus to the right shoulder and for the high position, the full measurement from the right shoulder to the umbilicus.

8. Attach the three-way stopcock and aspirate blood with a syringe. Clear the catheter with normal saline.

9. Anchor the catheter with silk suture to the umbilical stump.

10. Check the position of the catheter tip with an x-ray. It should be at the level of L4 for the low position, or between T6 and T9, which is above the diaphragm, for the high position.

Patency of the umbilical arterial line can be maintained by a continuous infusion of fluid. The catheter should be removed when the need for arterial blood gas monitoring is no longer necessary (oxygen requirement £ 80%) or complications occur.

Complications Possible complications of umbilical artery catheterization are infection, thrombosis and vasospasm, and hemorrhage. Renal hypertension is a delayed complication.

UMBILICAL VEIN CATHETERIZATION The most expedient procedure for obtaining vascular access is to insert the venous catheter through the umbilicus via the umbilical vein, and the ductus venosus into the inferior vena cava. The venous catheter should be inserted 10 to 12 cm and anchored to the abdominal wall. Obtain radiographs of chest and abdomen to rule out other abnormalities and evaluate the position of the catheters.

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