166 Section V ■ Vascular Access

7. Catheter-related vascular compromise

8. Onset of platelet consumption coagulopathy

9. Peritonitis

10. Necrotizing enterocolitis

11. Omphalitis

C D

A B

Fig. 29.14. Various UAC malpositions. A: Unacceptable position at L2 because of the proximity

of the renal arteries. B: UAC in left brachycephalic artery. C: UAC in right brachycephalic artery.

D: UAC in pelvic artery.

Technique

1. Leave umbilical tie loose around cord stump as precaution against excessive bleeding.

Reinsertion of purse-string suture through dried

Wharton jelly is preferable if

Chapter 29 ■ Umbilical Artery Catheterization 167

f. Sciatic nerve palsy (48)

g. Misdirection of catheter into internal or external

iliac artery (see Figs. 29.14D and 29.17) (39).

Schreiber et al. (42) have described a doublearterial catheter technique to correct this problem.

2. Vascular accident

a. Thrombosis (Fig. 29.18) (49–52)

b. Embolism/infarction (Fig. 29.17) (17,27) seen days

or weeks after line insertion (38)

c. Vasospasm (17,38,53,54) is seen within minutes to a

few hours after insertion.

d. Loss of extremity (Fig. 29.19) (53)

e. Hypertension (Fig. 29.20) (18,55)

f. Paraplegia (56)

g. Congestive heart failure (aortic thrombosis) (57)

h. Air embolism (Fig. 29.21)

3. Equipment-related

a. Breaks in catheter and transection of catheter (58)

b. Plasticizer in tissues (59,60)

c. Electrical hazard

(1) Improper grounding of electronic equipment

(2) Conduction of current through fluid-filled

catheter

d. Intravascular knot in catheter (61)

4. Other

a. Hemorrhage (including that related to catheter loss

or disconnection and overheparinization) (39,62,63)

A B