Vascular Access

Peripheral venous access in the neonate may be technically challenging and is usually performed successfully only by caretakers skilled in this technique. Femoral line placement is difficult in neonates and should rarely be considered. Intravascular lines placed through the umbilicus are a simple and desirable alternative for both arterial and venous access in infants less than 1 week of age. The most rapid way to obtain vascular access is to temporarily place an umbilical venous catheter (UVC) 2 to 3 cm below the level of the skin. A UVC located in this position can be used to administer fluid, medications, and pressors in emergency situations, but it is not a sufficiently stable form of access during transport. By contrast, UVCs with the tip located near the junction of the inferior vena cava and the right atrium are ideal for all infusions, both during stabilization and transport. The position of the tip of the catheter should be determined radiographically prior to use to ensure that medications are not being infused into the liver. An umbilical artery catheter is desirable when frequent blood gas analysis is anticipated or central blood pressure monitoring is crucial. However, umbilical artery catheters should not generally be used for the administration of pressors.

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