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Vascular Access

  • Steven M. DonnEmail author
Chapter
  1. I.
    Umbilical artery catheterization (UAC)
    1. A.
      Indications
      1. 1.
        Monitoring arterial blood gases
        1. a.

          FiO2  ≥  0.4

           
        2. b.

          Unreliable capillary samples

           
        3. c.

          Continuous monitoring

           
         
      2. 2.

        Need for invasive blood pressure monitoring

         
       
    2. B.
      Procedure
      1. 1.

        Elective procedure

         
      2. 2.

        Use sterile technique

         
      3. 3.

        Catheterize vessel after cutdown technique using 3.5 F (<1,500 g) or 5 F catheter

         
      4. 4.
        Preferred position of tip
        1. a.

          High (T7–T10)

           
        2. b.

          Low (L3–L4)

           
         
      5. 5.

        Confirm position radiographically

         
      6. 6.

        Secure with tape bridge and (optional) sutures

         
       
    3. C.
      Complications
      1. 1.

        Blood loss

         
      2. 2.

        Infection

         
      3. 3.
        Thrombo-embolic events
        1. a.

          Digit necrosis

           
        2. b.

          NEC

           
        3. c.

          Renal artery thrombosis

           
        4. d.

          Spinal cord injury (rare, but reported)

           
         
      4. 4.

        Vasospasm

         
      5. 5.

        Vessel perforation

         
      6. 6.

        Air embolus

         
      7. 7.

        Hypertension (renal artery thrombosis)

         
       
    4. D.
      Removal
      1. 1.

        When FiO2  <  0.4 and decreasing

         
      2. 2.

        When noninvasive blood pressure monitoring is adequate

         
      3. 3.

        At first signs of complications

         
       
    5. E.
      Comments
      1. 1.

        Confirm position. A...

Keywords

Exchange Transfusion Superficial Temporal Artery Great Saphenous Vein Vessel Perforation ELBW Infant 
These keywords were added by machine and not by the authors. This process is experimental and the keywords may be updated as the learning algorithm improves.

Suggested Reading

  1. Donn SM. Vascular catheters. In: Donn SM, editor. The Michigan Manual of neonatal intensive care. 3rd ed. Philadelphia, PA: Hanley & Belfus; 2003. p. 46–9.Google Scholar
  2. Feick HJ, Donn SM. Vascular access and blood sampling. In: Donn SM, Faix RG, editors. Neonatal emergencies. Mt, Kisco, NY: Futura; 1991. p. 31–50.Google Scholar
  3. Workman EL, Donn SM. Intravascular catheters. In: Donn SM, Fisher CW, editors. Risk management techniques in perinatal and neonatal practice. Armonk, NY: Futura; 1996. p. 531–49.Google Scholar

Copyright information

© Springer Science+Business Media, LLC 2012

Authors and Affiliations

  1. 1.Division of Neonatal–Perinatal MedicineC.S. Mott Children’s Hospital, F5790 Mott Hospital/5254, University of Michigan Health SystemAnn ArborUSA

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