• 
  

  • Emergency vascular access for fluid and medications.

  
  

  • Administration of high glucose concentration and total parenteral nutrition.

  
  

  • Central venous pressure monitoring.

  
  

  • Exchange transfusion.

Absolute

• 
  

  • Omphalitis.

  
  

  • Abdominal wall defects (eg, omphalocele, gastroschisis).

  
  

  • Necrotizing enterocolitis.

  
  

  • Umbilical surgery.

  
  

  • Peritonitis.

• 
  

  • 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 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 venous catheterization, very few are seen in practice if adequate precautions are observed.

  
  

  • The risk of infection is minimized by placing the catheter under sterile conditions and using a sterile technique for blood sampling from the catheter.

  
  

  • Catheters should be removed after 7 days of use to further decrease the chance of infection.

  
  

  • 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.

  
  

  • Embolization and thrombosis can occur.

• 
  

  • Position the catheter tip away from the origin of hepatic vessels, portal vein, and foramen ovale; the tip should lie in the inferior vena cava just below its junction with the right atrium.

  
  

  • Never force the catheter past an obstruction.

  
  

  • Once secured, never advance nonsterile portions of the catheter into the vessel. If the catheter needs to be advanced, it should be replaced.

  
  

  • Avoid hypertonic infusions when catheter tip is not in the inferior vena cava.

  
  

  • Do not leave the catheter open to the atmosphere due to the danger of air embolus.

  
  

  • Always confirm catheter position on radiograph before use. The only exception is when an umbilical venous catheter is inserted for resuscitation in the delivery room; in this case a low-lying catheter should be used.