INDWELLING CATHETERS |
Use of UVCs should be justified daily, recognizing risks of complications versus benefits of intravascular monitoring and access for blood sampling. Any catheter complication including blanching of digits, malfunction, or possible infection, should be documented in the chart and discussed with attending neonatologist or fellow.
Umbilical Arterial Catheters
Relative Indications:
A 3.5 French umbilical catheter should be inserted in infants less than 1250 grams. Catheters should be withdrawn if persistent blanching, decreased temperature, or loss of pulse is noted in an extremity. Any clinical changes in that extremity should be documented in the medical record, as should reasons for discontinuing a catheter. Umbilical arterial catheters are maintained in a high position (at the T6-T10 vertebral bodies). These are not used for hyperalimentation except at the direction of the attending physician. No blood transfusions are to be given through an arterial line.
BIRTH WEIGHT POSITION
< 700 gm
T10
700 - 1000gm
T9
1000 - 2000 gm
T8
< 2000 gm
T7
formula: umbilicus to shoulder in cm + BW in kg (to nearest 0.5 kg)
Umbilical Venous Catheters
Relative Indications:
Catheters should be discontinued at one week and replaced by a percutaneous silastic catheter to limit risk of infection and morbidity related to long term UVC placement; if central access is unavailable through an umbilical arterial catheter or if a percutaneous line cannot be placed, the line may be continued at the attending's discretion. Catheters should obviously be discontinued when blood can no longer be withdrawn through the catheter. Clotted umbilical venous catheters should only be replaced following discussion with attending neonatologist or fellow.
Hyperalimentation Lines
Hyperalimentation is given through either an umbilical venous catheter or another central line if an umbilical venous route is not available. Central lines are placed surgically or percutaneously.
Percutaneous Lines
Small silastic catheters placed percutaneously through a 19 gauge needle cannot be used for blood withdrawal or blood transfusion. Because these catheters are not radiopaque, their position must usually be verified with a 1 cc injection of Renografin.
Other Central Lines (UVC, Cutdowns)
At times, central catheters are the only available route for obtaining blood. If this is the case, laboratory studies should be obtained, if possible, once daily at hyperal change. If labs are required more frequently, they should be obtained by peripheral venipuncture or fingerstick. If an emergency situation requires interruption of hyperalimentation, this is done by the nursing staff using sterile technique. The remaining hyperalimentation solution may be reconnected following blood withdrawal. We do not use two bottles of hyperal for q12h interruption of the line.
Note: To minimize the risk of hypoglycemia and to treat early sepsis, IV solutions and ampicillin should be infused immediately after insertion of umbilical catheters, even before X-ray confirmation of placement.
Percutaneous Arterial Catheters
These may be placed in the radial or posterior tibial arteries. Normal saline with one unit of heparin/ml is the only fluid infused into these lines. They will only be used for withdrawal of arterial blood gasses unless an order is written, specifically permitting their use for other laboratory studies. Obviously, no transfusions should be given through these catheters. To maintain patency of perc art lines: 12/mg Papavarin/100 cc plus regular heparin.
Procedure Notes and Change In Status Notes
After every attempted procedure, successful or unsuccessful, a procedure note outlining the type of procedure, indication, outcome, and verification of position (if appropriate) should be written by the person performing procedure. Likewise, for any change in status (such as clinical deterioration leading to a septic workup), an note should be placed in the chart documenting the change.