23. Schafer T, Kukies S, Stokes TH, et al. The prepuce as a donor site

for reconstruction of an extravasation injury to the foot in a newborn. Ann Plast Surg. 2005;54:664.

24. Chen TK, Yang CY, Chen SJ. Calcinosis cutis complicated by

compartment syndrome following extravasation of calcium gluconate in a neonate: a case report. Pediatr Neonatol. 2010;51:

238.

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Mariam M. Said

Khodayar Rais-Bahrami

29 Umbilical Artery Catheterization

A. Indications

Catheters should remain in place only as long as primary

indications exist, with the exception of secondary indication

A3. Because of the risk of complications, catheters should

usually not remain in place for more than 2 weeks.

Primary

1. Frequent or continuous (see Chapter 10) measurement

of lower aortic blood gases for oxygen tension (PO2) or

oxygen content (percent saturation)

2. Continuous monitoring of arterial blood pressure

3. Angiography

4. Resuscitation (use of umbilical venous line may be first

choice)

Secondary

1. Umbilical artery is not usually used for infusion of maintenance glucose/electrolyte solutions or medications. If

this line is to be used to provide IV nutrition, the same

aseptic techniques used for any central line must be

used to prevent line-related sepsis (see Chapter 32).

2. Exchange transfusion

3. To provide vital infusions (1) and a port for frequent

blood sampling in the extremely low-birthweight infant

B. Contraindications

1. Evidence of vascular compromise in lower limbs or

buttock areas

2. Peritonitis

3. Necrotizing enterocolitis (2)

4. Omphalitis

5. Omphalocele

6. Acute abdomen etiology

C. Equipment

Several standardized graphs for premeasurement of catheter length to be inserted are available (Figs. 29.1–29.3).

Sterile

1. Sterile gown and gloves

2. Cup with antiseptic solution

3. Surgical drape with central aperture (transparent drape

recommended)

4. Catheter

a. Single hole

(1) Reduces surfaces for potential thrombus formation

(2) Recorded pressure tracing will change when

hole is occluded.

b. Made of flexible material that does not kink as it follows the curves of vessels

c. Relatively rigid walls with frequency characteristics

suitable for accurate measurement of intravascular

pressure

d. Small capacity (minimum volume of blood to be

withdrawn to clear catheter prior to blood sampling)

e. Radio-opaque: The need to visualize the catheter

position on x-ray film outweighs the theoretical risk

of increased thrombogenicity related to a radioopaque strip (3).

f. Smooth, rounded tip (4), nonthrombogenic material (5)