What is the purpose of an umbilical catheter for a newborn, particularly a preterm newborn, in a hospital setting?

What is an Umbilical Catheter for Newborns in the Hospital?

An umbilical catheter is a central venous line inserted through the umbilical cord stump of a newborn to provide rapid vascular access for administering medications, fluids, parenteral nutrition, blood sampling, and monitoring blood pressure during the first days of life. 1, 2

Types of Umbilical Catheters

There are two main types of umbilical catheters used in neonatal care:

• Umbilical Venous Catheter (UVC): Inserted into the umbilical vein, providing central venous access for fluid and medication administration 3
• Umbilical Arterial Catheter (UAC): Inserted into one of the umbilical arteries, primarily used for blood pressure monitoring and frequent blood sampling 4, 5

Primary Clinical Indications

Umbilical venous catheterization is the preferred first-line method for vascular access during newborn resuscitation in the delivery room. 1, 2 The UVC is particularly valuable for:

• Emergency resuscitation: Administering epinephrine, volume replacement, and other resuscitation medications in critically ill newborns 1, 2
• Preterm and very low birth weight infants: Standard practice for infants <30 weeks gestational age or <1250g requiring parenteral nutrition and medications 6
• Stable intravenous access: Providing a reliable route when peripheral access is difficult or impossible 3
• Blood sampling: Allowing frequent laboratory draws without repeated venipunctures 7, 4

Why Umbilical Access is Preferred

The umbilical vein remains patent for several days after birth, making it:

• Easily accessible immediately after delivery: Can be inserted within minutes of birth without requiring specialized equipment 2
• The most commonly taught technique: Neonatal providers are extensively trained in this procedure 1
• Less invasive than alternatives: Avoids the complications associated with intraosseous access in neonates, including tibial fractures, compartment syndrome, and amputation 1, 8

Alternative Vascular Access

If umbilical venous access is not feasible or fails, intraosseous (IO) access is the recommended alternative during newborn resuscitation. 1, 2 However, IO access carries significant risks in neonates and should be removed as soon as alternative IV access is established, ideally within 24 hours. 8

Outside the delivery room setting, either umbilical venous access or IO route may be used based on local availability, training, and experience. 1

Duration of Use

Recent evidence suggests that:

• Traditional practice: UVCs are typically removed within 1-5 days of life and replaced with peripherally inserted central catheters (PICCs) if continued central access is needed 6
• Emerging evidence: Extended UVC dwell time of 6-10 days may not increase complication rates and can reduce the number of painful invasive procedures, radiation exposure, and medical costs 6
• Standard equipment: UVC sizes of 3.5F and 5.0F should be available in all emergency departments caring for children 1

Common Complications Requiring Monitoring

Caregivers must systematically assess for UVC-related complications, including:

• Thrombosis and embolism: Can lead to vascular compromise 7, 4
• Catheter malposition: Up to 40% of UVCs placed without ultrasound guidance are not in optimal central position 3
• Infection: Catheter-related bloodstream infections are a significant risk 6, 4
• Organ injury: Including hepatic necrosis, cardiac complications, and gastrointestinal damage 4
• Hemorrhage and vessel perforation: Particularly during insertion 4, 5

Critical Practice Points

Point-of-care ultrasound should be used to verify proper UVC tip placement in the inferior vena cava near the right atrium to minimize complications. 3 The feasibility of targeted ultrasound training for neonatal medical staff has been demonstrated, and this technique should be widespread among all physicians performing UVC placement. 3

Despite over 60 years of use, there are still no standardized guidelines for UVC assessment, monitoring, securement, management, or optimal dwell time, highlighting the need for institutional protocols based on best available evidence. 3