If a newborn needs emergent intravenous access for medications such as epinephrine or fluids, an umbilical equipment tray must have all the necessary materials to access the baby’s umbilical vein quickly. Having this tray prepared in advance will keep the team from wasting precious minutes needed to prevent disability or death.
In order to insert this catheter, be sure to follow these steps:
- Have a complete umbilical insertion kit at the bedside with all the necessary equipment and supplies to access the baby’s umbilical vein emergently.
There are several umbilical insertion tray kits available. Be sure yours includes: sterile gloves, normal saline flushes, betadine swabs, drapes, and umbilical catheters in both 3.5 French and 5.0 French sizes.
- Open the kit sterilely.
- After putting on sterile gloves, use the sterile prefilled 10 ml normal saline flushes to prime the umbilical catheter and 3-way stopcock.
Keep in mind that standard normal saline flushes are not sterile on the outside despite being wrapped in plastic.
- Attach a 3-way stopcock to either the 3.5 French for a preterm infant, or the 5.0 French umbilical catheter for a term infant.
- Attach the 10-ml syringe filled with normal saline to the 3-way stopcock.
- Turn the stopcock off to the side port with the cap on it.
- Flush normal saline until you see it coming out the end of the umbilical catheter.
- Turn the stopcock off toward the umbilical catheter.
- Rotate the stopcock so that the side port cap is facing up to the ceiling.
- Remove the cap.
- Flush with normal saline until there is no air in the side port.
After replacing the cap, the line is now ready to be placed into the umbilical vein.
- Prepare the umbilical stump.
For a distressed baby, leave a long umbilical cord stump. The plastic umbilical clamp should be 8–10 cm above the point of insertion.
- Hand a Kelly clamp to the medication nurse so that she can hold the umbilical clamp up while you use the 3 betadine swab sticks to quickly paint the umbilical cord, umbilical clamp, and a 10 cm circular area around the umbilical cord at its insertion point.
- Place rectangular sterile drapes horizontally and vertically along the umbilical cord.
- Tie the umbilical cord tape around the base of the umbilical cord to prevent excess bleeding.
- Straight clamp the umbilical cord just below the umbilical clamp still being held up by the medication nurse.
- Using your 11-blade scalpel, cut above your straight clamp, releasing the umbilical clamp.
- Meanwhile, the medication nurse should prepare the resuscitation medications, having them ready to administer after the line is placed.
- To complete the draping, insert the umbilical cord through an eye-hole drape.
- Bring the umbilical catheter 3-way stopcock-normal saline flush assembly, 11-blade scalpel, and 2 pairs of forceps to your sterile area.
- Using the scalpel, cut below the metal straight clamp about 1 cm above the insertion point.
- Holding the umbilical cord with 1 pair of forceps, identify the umbilical vein with your other pair of forceps.
- Dilate as needed by pinching the ends of the forceps together and moving them circularly inside the umbilical vein.
- Using your forceps or your fingers, gently place the umbilical catheter into the umbilical vein.
- Insert the catheter 2–4 cm or until blood is aspirated.
- Administer medications and then flush with 0.5–1 ml of normal saline.
Be careful not to force an umbilical catheter while inserting it because you only have one umbilical vein. If you can’t access the umbilical vein, you will need to place a peripheral intravenous catheter, insert an intraosseus line, or administer medications through the endotracheal tube.
These steps will give you the ability to safely and quickly obtain emergency intravenous access with which to administer life-saving fluids and medications.