For how long can an umbilical catheter (UC) be safely used?

Duration of Umbilical Catheter Use

Umbilical venous catheters (UVCs) can be safely used for up to 14 days if managed aseptically, while umbilical artery catheters (UACs) should not be left in place for more than 5 days. 1

Recommended Duration for Umbilical Catheters

• Umbilical artery catheters (UACs) should optimally not be left in place for more than 5 days 1
• Umbilical venous catheters (UVCs) can be safely used for up to 14 days if managed aseptically 1
• Both types of umbilical catheters should be removed as soon as possible when no longer needed 1

Indications for Early Removal

• Remove umbilical artery catheters immediately if any signs of catheter-related bloodstream infection (CRBSI), vascular insufficiency in the lower extremities, or thrombosis are present 1
• Remove umbilical venous catheters immediately if any signs of CRBSI or thrombosis are present 1
• Remove umbilical catheters when any sign of vascular insufficiency to the lower extremities is observed 1

Catheter Replacement Guidelines

• An umbilical catheter may be replaced if it is malfunctioning, with no other indication for removal, and the total duration has not exceeded the recommended limits (5 days for UAC, 14 days for UVC) 1
• Do not replace umbilical catheters if there are signs of infection or thrombosis 1

Infection Prevention Measures

• Cleanse the umbilical insertion site with an antiseptic before catheter insertion 1
• Avoid tincture of iodine due to potential effects on the neonatal thyroid; other iodine-containing products like povidone-iodine can be used 1
• Do not use topical antibiotic ointment or creams on umbilical catheter insertion sites as they may promote fungal infections and antimicrobial resistance 1
• Add low-doses of heparin (0.25–1.0 U/ml) to the fluid infused through umbilical arterial catheters 1

Recent Research Considerations

• A 2023 pilot study found that a longer UVC dwell-time of up to 14 days significantly decreased the number of painful invasive vascular procedures and radiation exposure compared to shorter durations (1-7 days) 2
• The same study showed shorter hospital stays with longer UVC dwell times without increased complications 2
• However, some recent guidelines suggest limiting UVC dwell time to 7-10 days to reduce infectious and thrombotic complications, though this remains controversial 3

Special Considerations and Pitfalls

• Monitor closely for signs of infection, which include fever, chills, and hypotension with no apparent source other than the catheter 1
• Be vigilant for thrombosis formation, particularly in small-for-gestational-age infants who may have a higher risk (20% vs 9% in other infants) 4
• When removing catheters, ensure they are removed under aseptic conditions to prevent introducing infection 1
• Document the date of catheter insertion and establish a schedule for monitoring and potential removal based on the recommended timeframes 1