Umbilical Venous Catheterization Target
The appropriate target for umbilical venous catheterization is the thin-walled vessel at 12 o'clock oozing blood, which represents the single umbilical vein.
Anatomical Identification
The umbilical cord contains three vessels with distinct characteristics that guide proper catheterization 1:
The umbilical vein (correct target): A single, thin-walled vessel typically located at the 12 o'clock position that appears larger and may be oozing blood due to its thin walls and lack of muscular tone 1
The umbilical arteries (avoid these): Two thick-walled vessels with smaller lumens that typically do not bleed as readily due to their muscular walls and tendency to vasospasm after cord clamping 1
Clinical Rationale for Umbilical Venous Access
Umbilical venous catheterization is the primary recommended method of vascular access during newborn resuscitation in the delivery room 1. This approach is preferred because:
It provides the fastest, most stable, and easiest route to guarantee emergency therapy, hemodynamic monitoring, and parenteral nutrition in critically ill neonates 1
The technique is most commonly taught to and used by neonatal providers, making it the standard of care 1
Public feedback and expert consensus emphasize umbilical venous access as the preferred method over alternatives like intraosseous access 1
Common Pitfalls to Avoid
Do not catheterize the umbilical arteries when venous access is intended, as this would result in arterial rather than venous access and carries different risks including thrombotic complications 2. The thick-walled vessels (umbilical arteries) should be avoided for venous catheterization purposes.
Verify proper vessel identification before insertion: The thin-walled, larger-caliber vessel that may be oozing blood is your target, not the smaller thick-walled vessels that typically stop bleeding due to arterial spasm 1, 3.