g. 5-French (Fr) gauge for infants weighing >1,200 g

h. 3.5-Fr gauge for infants weighing <1,200 g

5. Three-way stopcock with Luer-Lock

6. 10-mL syringe

7. 0.45 to 0.9 normal saline (NS) flush solution (saline

with heparin, 1 to 2 U/mL)

In very small premature infants, particularly in the

first week of life, hypernatremia may result from receiving excess sodium in flush solutions. We recommend

using 0.45 NS rather than more concentrated saline

solutions in these infants. The use of hypotonic (0.25

NS) or dextrose solutions has been associated with

hemolysis of red blood cells and should be avoided if

possible (6). Use of heparinized flush solution is common practice. Rajani et al. and Ankola and Atakent

(7,8) have shown that using a heparinized solution containing 1 U/mL heparin for flushing the umbilical arterial line prolonged catheter life by reducing the

incidence of fibrin thrombus formation in the catheter

lumen. Horgan et al. (9) found that the use of 1 U/mL

heparin did not reduce the incidence of umbilical

artery catheter (UAC)-related thrombi but did lower the

Chapter 29 ■ Umbilical Artery Catheterization 157

incidence of their sequelae. Butt et al. (10) could demonstrate no significant benefit associated with increasing the

rate of infusion from 1 to 2 mL/h (heparin 1 U/mL), and

Bosque and Weaver (11) showed that continuous infusion

of 1 U/mL heparin is more effective than intermittent

infusion in maintaining patency of the UAC. More

recent data have indicated that heparin decreases the

incidence of thrombotic complications (12), and a

Cochrane Database Review found that the use of as little

as 0.25 U/mL heparin in the infusate decreases the likelihood of line occlusion (13).

8. Tape measure

9. 20-cm narrow umbilical tie

10. No. 11 scalpel blade and holder

11. 4- × 4-inch gauze sponges

12. Two curved mosquito hemostats

13. Toothed iris forceps

14. Two curved, nontoothed iris forceps

15. 2% lidocaine HCl without epinephrine

16. 3-mL syringe and needle to draw up lidocaine

17. Small needle holder

18. 4-0 silk suture on small, curved needle

19. Suture scissors

Nonsterile

1. Cap and mask

2. Wooden tongue depressor

D. Precautions

1. Avoid use of feeding tubes as catheter (associated with

higher incidence of thrombosis) (14).

2. Fold drapes so as not to obscure infant’s face and upper

chest.