Umbilical line

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Umbilical Line
Umbilical Catheter.png
Specialty Neonatology

An umbilical line is a catheter that is inserted into one of the two arteries or the vein of the umbilical cord. Generally the UAC/UVC (Umbilical Artery Catheter/Umbilical Vein Catheter) is used in Neonatal Intensive Care Units (NICU) as it provides quick access to the central circulation of premature infants. UAC/UVC lines can be placed at the time of birth and allow medical staff to quickly infuse fluids, inotropic drugs, and blood if required. It is sometimes used in term or near-term newborns in whom the umbilical cord stump is still connected to the circulatory system. Medications, fluids, and blood can be given through this catheter and it allows monitoring of blood gasses and withdrawing of blood samples. Transumbilical catheter intervention is also a method of gaining access to the heart, for example to surgically correct a patent ductus arteriosus. [1]

Contents

Complications

The complications of umbilical lines are similar to those of central venous catheters mainly infections such as neonatal sepsis and thrombosis. The most common organisms causing these infections are coagulase negative staphylococci such as staphylococcus epidermidis [2] To avoid catheter-related bloodstream infections checklists and care bundles focused on strict hygiene routines are often recommended. [3] [4] [5]

Umbilical arterial catheter

The position of an umbilical arterial catheter is confirmed on plain film. From the umbilicus, the umbilical arterial catheter dives inferiorly and joins the right or left internal iliac artery before turning superiorly to the common iliac artery and aorta. Appropriate positioning of the catheter tip can be either 'high' or 'low.' The high range is judged relative to thoracic vertebra, and is between T6 and T10, to avoid major aortic branches. The low range is relative to lumbar vertebra, and is between L3 and L5. The lower position may be associated with a higher rate of vascular complications such as thrombosis or vasospasm. [6]

Umbilical venous catheter

Anomalous positioning of the umbilical venous catheter occurs frequently because it is usually inserted without imaging guidance, and confirmed after placement on subsequent plain film, occurring in approximately 50% of first attempts. From the umbilical vein at the umbilicus, the catheter curves superiorly and to the right, joining the left portal vein, passing through the patent ductus venosus to the inferior vena cava and right atrium. Appropriate UVC tip position is in the high inferior vena cava to the low right atrium, typically within 1 cm of the diaphragm. If the UVC tip is proximal to ductus venosus it can lead to administration of intravenous fluids into the portal system, with potential portal vein thrombosis, or, in cases of TPN administration, a TPN abscess. [7]

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<span class="mw-page-title-main">Vein</span> Blood vessels that carry blood towards the heart

Veins are blood vessels in the circulatory system of humans and most other animals that carry blood towards the heart. Most veins carry deoxygenated blood from the tissues back to the heart; exceptions are those of the pulmonary and fetal circulations which carry oxygenated blood to the heart. In the systemic circulation, arteries carry oxygenated blood away from the heart, and veins return deoxygenated blood to the heart, in the deep veins.

<span class="mw-page-title-main">Circulatory system</span> Organ system for circulating blood in animals

The circulatory system is a system of organs that includes the heart, blood vessels, and blood which is circulated throughout the entire body of a human or other vertebrate. It includes the cardiovascular system, or vascular system, that consists of the heart and blood vessels. The circulatory system has two divisions, a systemic circulation or circuit, and a pulmonary circulation or circuit. Some sources use the terms cardiovascular system and vascular system interchangeably with circulatory system.

<span class="mw-page-title-main">Central venous catheter</span> A tubular device placed in a large vein used to administer medicines

A central venous catheter (CVC), also known as a central line (c-line), central venous line, or central venous access catheter, is a catheter placed into a large vein. It is a form of venous access. Placement of larger catheters in more centrally located veins is often needed in critically ill patients, or in those requiring prolonged intravenous therapies, for more reliable vascular access. These catheters are commonly placed in veins in the neck, chest, groin, or through veins in the arms.

<span class="mw-page-title-main">Umbilical cord</span> Conduit between embryo/fetus and the placenta

In placental mammals, the umbilical cord is a conduit between the developing embryo or fetus and the placenta. During prenatal development, the umbilical cord is physiologically and genetically part of the fetus and normally contains two arteries and one vein, buried within Wharton's jelly. The umbilical vein supplies the fetus with oxygenated, nutrient-rich blood from the placenta. Conversely, the fetal heart pumps low-oxygen, nutrient-depleted blood through the umbilical arteries back to the placenta.

<span class="mw-page-title-main">Femoral artery</span> Large artery in the thigh

The femoral artery is a large artery in the thigh and the main arterial supply to the thigh and leg. The femoral artery gives off the deep femoral artery and descends along the anteromedial part of the thigh in the femoral triangle. It enters and passes through the adductor canal, and becomes the popliteal artery as it passes through the adductor hiatus in the adductor magnus near the junction of the middle and distal thirds of the thigh.

<span class="mw-page-title-main">Umbilical vein</span> Vein running from the placenta to the fetus

The umbilical vein is a vein present during fetal development that carries oxygenated blood from the placenta into the growing fetus. The umbilical vein provides convenient access to the central circulation of a neonate for restoration of blood volume and for administration of glucose and drugs.

<span class="mw-page-title-main">Umbilical artery</span> Artery in the abdominal and pelvic regions

The umbilical artery is a paired artery that is found in the abdominal and pelvic regions. In the fetus, it extends into the umbilical cord.

<span class="mw-page-title-main">Abdominal aorta</span> Largest artery in the abdomen

In human anatomy, the abdominal aorta is the largest artery in the abdominal cavity. As part of the aorta, it is a direct continuation of the descending aorta.

<span class="mw-page-title-main">Transposition of the great vessels</span> Group of congenital heart defects

Transposition of the great vessels (TGV) is a group of congenital heart defects involving an abnormal spatial arrangement of any of the great vessels: superior and/or inferior venae cavae, pulmonary artery, pulmonary veins, and aorta. Congenital heart diseases involving only the primary arteries belong to a sub-group called transposition of the great arteries (TGA), which is considered the most common congenital heart lesion that presents in neonates.

<span class="mw-page-title-main">Femoral vein</span> Large blood vessel in the leg

In the human body, the femoral vein is the vein that accompanies the femoral artery in the femoral sheath. It is a deep vein that begins at the adductor hiatus as the continuation of the popliteal vein. The great saphenous vein, and the deep femoral vein drain into the femoral vein in the femoral triangle when it becomes known as the common femoral vein. It ends at the inferior margin of the inguinal ligament where it becomes the external iliac vein. Its major tributaries are the deep femoral vein, and the great saphenous vein. The femoral vein contains valves.

<span class="mw-page-title-main">Ductus venosus</span> Vein in the human fetus

In the fetus, the ductus venosus shunts a portion of umbilical vein blood flow directly to the inferior vena cava. Thus, it allows oxygenated blood from the placenta to bypass the liver. Compared to the 50% shunting of umbilical blood through the ductus venosus found in animal experiments, the degree of shunting in the human fetus under physiological conditions is considerably less, 30% at 20 weeks, which decreases to 18% at 32 weeks, suggesting a higher priority of the fetal liver than previously realized. In conjunction with the other fetal shunts, the foramen ovale and ductus arteriosus, it plays a critical role in preferentially shunting oxygenated blood to the fetal brain. It is a part of fetal circulation.

<span class="mw-page-title-main">Foramen ovale (heart)</span> Passageway between the atria of the human heart

In the fetal heart, the foramen ovale, also foramen Botalli or the ostium secundum of Born, allows blood to enter the left atrium from the right atrium. It is one of two fetal cardiac shunts, the other being the ductus arteriosus. Another similar adaptation in the fetus is the ductus venosus. In most individuals, the foramen ovale closes at birth. It later forms the fossa ovalis.

Omphalitis of newborn is the medical term for inflammation of the umbilical cord stump in the neonatal newborn period, most commonly attributed to a bacterial infection. Typically immediately after an infant is born, the umbilical cord is cut with a small remnant left behind. Normally the stump separates from the skin within 3–45 days after birth. A small amount of pus-like material is commonly seen at the base of the stump and can be controlled by keeping the stump open to air to dry. Certain bacteria can grow and infect the stump during this process and as a result significant redness and swelling may develop, and in some cases the infection can then spread through the umbilical vessels to the rest of the body. While currently an uncommon anatomical location for infection in the newborn in the United States, it has caused significant morbidity and mortality both historically and in areas where health care is less readily available. In general, when this type of infection is suspected or diagnosed, antibiotic treatment is given, and in cases of serious complications surgical management may be appropriate.

<span class="mw-page-title-main">Fetal circulation</span> Circulatory system of fetuses

In humans, the circulatory system is different before and after birth. The fetal circulation is composed of the placenta, umbilical blood vessels encapsulated by the umbilical cord, heart and systemic blood vessels. A major difference between the fetal circulation and postnatal circulation is that the lungs are not used during the fetal stage resulting in the presence of shunts to move oxygenated blood and nutrients from the placenta to the fetal tissue. At birth, the start of breathing and the severance of the umbilical cord prompt various changes that quickly transform fetal circulation into postnatal circulation.

<span class="mw-page-title-main">May–Thurner syndrome</span> Medical condition

May–Thurner syndrome (MTS), also known as the iliac vein compression syndrome, is a condition in which compression of the common venous outflow tract of the left lower extremity may cause discomfort, swelling, pain or iliofemoral deep vein thrombosis.

<span class="mw-page-title-main">Testicular vein</span> Blood vessel which drains one of the testicles

The testicular vein, the male gonadal vein, carries deoxygenated blood from its corresponding testis to the inferior vena cava or one of its tributaries. It is the male equivalent of the ovarian vein, and is the venous counterpart of the testicular artery.

<span class="mw-page-title-main">Venography</span> X-ray imaging method for veins

Venography is a procedure in which an X-ray of the veins, a venogram, is taken after a special dye is injected into the bone marrow or veins. The dye has to be injected constantly via a catheter, making it an invasive procedure. Normally the catheter is inserted by the groin and moved to the appropriate site by navigating through the vascular system.

A fetus or foetus is the unborn mammalian offspring that develops from an embryo. Following the embryonic stage, the fetal stage of development takes place. Prenatal development is a continuum, with no clear defining feature distinguishing an embryo from a fetus. However, in general a fetus is characterized by the presence of all the major body organs, though they will not yet be fully developed and functional, and some may not yet be situated in their final anatomical location.

<span class="mw-page-title-main">Neonatal infection</span> Human disease

Neonatal infections are infections of the neonate (newborn) acquired during prenatal development or within the first four weeks of life. Neonatal infections may be contracted by mother to child transmission, in the birth canal during childbirth, or after birth. Neonatal infections may present soon after delivery, or take several weeks to show symptoms. Some neonatal infections such as HIV, hepatitis B, and malaria do not become apparent until much later. Signs and symptoms of infection may include respiratory distress, temperature instability, irritability, poor feeding, failure to thrive, persistent crying and skin rashes.

In medicine, vascular access is a means of accessing the bloodstream through the peripheral or central blood vessels in order to obtain blood or deliver medications including chemotherapy. A vascular access procedure involves insertion of a sterile plastic tube called a catheter into a blood vessel. Types of catheters can be either peripherally or centrally located. Peripheral catheters are approximately one inch (25 mm) long and are inserted into the small veins of the forearm. Central catheters are bigger and longer and are inserted into the large veins of the extremities, neck, or chest. Central venous catheters are the primary modality used for delivery of chemotherapeutic agents. The duration of central venous catheterization is dependent on the type of treatment given.

References

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  2. Bizzarro MJ, Shabanova V, Baltimore RS, Dembry LM, Ehrenkranz RA, Gallagher PG (May 2015). "Neonatal sepsis 2004-2013: the rise and fall of coagulase-negative staphylococci". The Journal of Pediatrics. 166 (5): 1193–1199. doi:10.1016/j.jpeds.2015.02.009. PMC   4413005 . PMID   25919728.
  3. "BSI | Guidelines Library | Infection Control | CDC". www.cdc.gov. 2020-01-03. Retrieved 2022-03-04.
  4. Björkman L, Ohlin A (March 2015). "Scrubbing the hub of intravenous catheters with an alcohol wipe for 15 sec reduced neonatal sepsis". Acta Paediatrica. 104 (3): 232–236. doi:10.1111/apa.12866. PMID   25399485.
  5. Bierlaire S, Danhaive O, Carkeek K, Piersigilli F (February 2021). "How to minimize central line-associated bloodstream infections in a neonatal intensive care unit: a quality improvement intervention based on a retrospective analysis and the adoption of an evidence-based bundle". European Journal of Pediatrics. 180 (2): 449–460. doi:10.1007/s00431-020-03844-9. PMID   33083900.
  6. Oestreich AE (December 2010). "Umbilical vein catheterization--appropriate and inappropriate placement". Pediatric Radiology. 40 (12): 1941–1949. doi:10.1007/s00247-010-1840-2. PMID   20890597.
  7. Coley BD, Seguin J, Cordero L, Hogan MJ, Rosenberg E, Reber K (December 1998). "Neonatal total parenteral nutrition ascites from liver erosion by umbilical vein catheters". Pediatric Radiology. 28 (12): 923–927. doi:10.1007/s002470050500. PMID   9880632.