Emergency Umbilical Venous Line

Introduction

This tutorial provides a step-by-step guide on how to place an emergency umbilical venous line in neonates, particularly for those under 10 days of age. This procedure is crucial for establishing vascular access in critically ill infants, especially when traditional IV access may be challenging.

Step 1: Gather Required Supplies

Prepare all necessary materials before starting the procedure. You will need:

• Sterile gloves
• Sterile drape
• Antiseptic solution (e.g., Betadine)
• 11-blade scalpel
• Umbilical tape (or suture if tape is unavailable)
• Hemostat or forceps
• 5-French umbilical line or feeding tube
• Saline-filled syringe connected to a 3-way stopcock
• Adhesive tape

Step 2: Prepare the Area

1. Clean the Umbilical Cord: Use the antiseptic solution to thoroughly clean the umbilical cord and surrounding skin. This reduces the risk of infection.
2. Drape the Patient: Place a sterile drape around the umbilicus to maintain a sterile field.
3. Prepare the Umbilical Tape: Wrap the umbilical tape around the base of the umbilicus, tying a loose knot. Ensure it is not too tight to allow for easier line advancement. If umbilical tape is not available, a suture may be used.

Step 3: Cut the Umbilical Cord

1. Position the Cord: Use hemostats or forceps to hold the distal portion of the umbilical cord.
2. Make the Cut: Cut the umbilical cord 1-2 cm from the base. This exposes the vessels.

Step 4: Identify and Prepare the Vein

1. Locate the Vessels: Examine the cut umbilical cord for two umbilical arteries (the "eyes") and one umbilical vein (the "mouth").
2. Clear Any Clots: If there are clots in the vein, use forceps to gently remove them and dilate the vein if necessary.

Step 5: Insert the Umbilical Line

1. Flush the Line: Prepare the umbilical line or feeding tube by flushing it with saline.
2. Insert the Line:
   • Insert the umbilical line into the umbilical vein.
   • Use forceps to pull the vein outward and upward while inserting the line.
3. Aspirate to Confirm Placement: Have an assistant aspirate while you insert the line.
   • Avoid advancing too deeply; if blood is aspirated, insert the line only 1 cm further (total depth should be 4-5 cm).
   • If no blood is aspirated after 4-5 cm, you may be in a false lumen and should remove the line and attempt re-insertion.

Step 6: Secure the Umbilical Line

1. Tighten the Umbilical Tape: Secure the knot in the umbilical tape or suture at the base of the umbilicus.
2. Use the H-Tape Method:
   • Place two strips of tape across the umbilical line, securing it to the baby's abdomen.
   • Ensure that the line has enough slack to prevent it from being easily dislodged but is secure enough to stay in place.

Conclusion

Once the umbilical venous line is secured, it can be used immediately for infusions without the need for radiographic confirmation, provided that blood has been aspirated and the line is not deeper than 5 cm. This technique is vital for providing quick access to fluids and medications in critically ill neonates. Always monitor the line post-placement for any complications or signs of dislodgment.