162 Section V ■ Vascular Access

20. Insert catheter into lumen of artery, between prongs of

dilating forceps (Fig. 29.11).

21. Remove curved forceps, having passed catheter approximately 2 cm into vessel with a firm, steady motion.

Grasp cord again with toothed tissue forceps and pull

gently toward head of infant. This mild traction will

facilitate passage of catheter at an angle between the

cord and the abdominal wall.

22. After passing the catheter approximately 5 cm, aspirate

to verify intraluminal position. Clear blood by injecting

0.5 mL of flush solution. Advance catheter to calculated appropriate length.

23. Take appropriate action if insertion is complicated (Fig.

29.12).

a. Resistance before tip reaches abdominal wall

(<3 cm from surface of abdominal stump)

(1) Loosen umbilical tape.

(2) Redilate artery.

b. “Popping” sensation rather than “relaxation”

(1) Catheter may have exited lumen and created a

false channel.

(2) Remove and use second artery.

(3) If unsuccessful, draw 0.5 mL of lidocaine from

vial. Reinsert tip of catheter approximately 2 cm

into UAC and drip lidocaine into vessel. Apply

constant gentle pressure until vessel dilates.

c. Backflow of blood, particularly around vessel

(1) Tighten umbilical tape.

(2) Catheter may be in false channel, with extravascular bleeding.

d. Resistance is encountered at anterior abdominal wall

or sharp turn in vessel as it angles around bladder

toward internal iliac artery (approximately 6 to 8 cm

from surface of umbilical stump in 2- to 4-kg neonate).

(1) Apply gentle but steady pressure for 30 to 60 seconds.

A

D

B

C