1. Remove any tape and withdraw catheter slowly, as
described earlier in this chapter.
2. If the internal ligature around a catheter is too tight to
Fig. 29.13. Subumbilical cutdown. Anatomic view through
incision. (Redrawn from Sherman NJ. Umbilical artery cutdown.
J Pediatr Surg. 1977;12:723, with permission.)
Chapter 29 ■ Umbilical Artery Catheterization 165
3. Apply pressure for hemostasis.
4. Approximate wound edges with skin-closure tape.
1. Catheterization of urachus (30)
2. Vesicoumbilical fistula (30)
3. Transection of urachus with urinary ascites (31)
4. Perforation or rupture (32,33) of urinary bladder—
although Nagarajan (33) has suggested that the risk of
bladder injury is minimal if bladder is emptied prior to
5. Transection of umbilical artery with hemorrhage
6. Incision of peritoneum (with possible evisceration)
For setup and maintenance of arterial pressure transducer,
1. Keep catheter free of blood to prevent clot formation.
a. Flush catheter with 0.5 mL of flush solution, slowly
over at least 5 seconds, each time a blood sample is
b. Between samples, infuse IV solution continuously
through catheter to prevent retrograde flow.
c. Note amounts of blood removed and IV fluid/flush
solution infused, and add to fluid balance record.
2. Watch for indications of clot formation.
a. Decrease in amplitude of pulse pressure on blood
b. Difficulty withdrawing blood samples
3. Take appropriate action if clot forms.
a. Do not attempt to flush clot forcibly.
Remove catheter. Replace only if critical.
studies have shown no increased incidence of feeding
problems or complications in infants fed with a UAC
H. Obtaining Blood Samples from
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