Removal of Catheter

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

allow removal with reasonable traction, it may be necessary to dissect and cut the ligature, after sterile skin

preparation.

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.

Complications

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

procedure.

5. Transection of umbilical artery with hemorrhage

6. Incision of peritoneum (with possible evisceration)

7. Bleeding from incision

G. Care of Dwelling Catheter

For setup and maintenance of arterial pressure transducer,

see Chapter 9.

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

drawn.

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

pressure tracing

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.

4. Enteral feeding in the presence of UACs remains controversial. Increased risk of mesenteric thromboembolism and its association with the development of necrotizing enterocolitis has been suggested (34). Other

studies have shown no increased incidence of feeding

problems or complications in infants fed with a UAC

in situ (35).

H. Obtaining Blood Samples from

Catheter

(With emphasis on aseptic technique and minimizing stress

to the vessel)

Equipment