• Sterile catheter
• Use 3.5F catheter for patients weighing < 1500 g.
• Use 5F catheter for patients weighing > 1500 g.
• Sterile umbilical catheter tray includes the following:
• Sterile drapes.
• Povidone-iodine and alcohol swabs.
• Umbilical tie.
• Toothed iris forceps.
• 2 curved non-toothed hemostats.
• Suture scissors.
• Small needle holder.
• 3-0 silk suture on small curved needle.
• 3-way stopcock with Luer-Lok.
• 3-mL and 1-mL syringes with needles.
• 2 × 2 gauze.
• 4 × 4 gauze.
• Saline solution with heparin 1 unit/mL.
• Although serious complications have been reported from arterial catheterization, very few are seen in practice if adequate precautions are observed.
• Bacterial colonization of umbilical arterial catheters has been reported to be as high as 60%; however, bacteremia occurs in less than 5% of infants.
• The risk of infection is minimized by placing the catheter under sterile conditions and using a sterile technique for blood sampling from the catheter.
• Infection risks are low because most infants who require an umbilical arterial catheter are receiving antibiotic therapy for other reasons.
• Hemorrhage may occur if the catheter inadvertently becomes disconnected or dislodged; however, this is avoided by maintaining exposure of the umbilical site at all times in an isolette or radiant warmer, together with constant nursing supervision.
• Approximately 5% of catheters decrease circulation to 1 or both legs, especially in infants weighing < 1000 grams.
• If this occurs, the catheter should be removed.
• Circulation usually returns to the extremity within an hour.
• Embolization and thrombosis can occur.
• Always observe the infant’s face, chest, and lower extremities during catheter placement.
• Carefully dilate the lumen of the artery before attempting to introduce the catheter.
• Do not attempt to force the catheter past an obstruction; this may result in vessel perforation requiring surgical intervention and blood volume replacement.
• Once secured, never advance nonsterile portions of the catheter into the vessel. If the catheter needs to be advanced, it should be replaced.
• Insertion of an umbilical arterial catheter to a “high” position is associated with fewer complications and is generally preferred.
• Always confirm catheter position on radiograph before use.
