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repetitive stretching is most effective with a solid metal dilator or the curved iris
forceps. An attempt at catheter placement should be undertaken when the artery
remains dilated to a diameter that is greater than that of the catheter for a depth of
1 cm.
To insert the catheter, hold the distal end near the tip as in Figure 130.8B , part
C, and place it in the arterial lumen between the prongs of the forceps that are
holding open the artery. An alternative method, pictured in Figure 130.8B , part
C, shows the inner wall of the vessel held with a 22-gauge needle (bent in the
shape of a hook by a hemostat), allowing the vessel to be entered directly. Pass
the catheter under gentle, constant forward pressure to overcome the resistance
encountered at the points where the artery turns (just below the skin surface and
where the arteries turn upward toward the iliacs; Fig. 130.8A ). Blood should
flow readily after the second bend when the internal iliac artery is entered.
As shown in Figure 130.8B , part D, advance the catheter to the appropriate
depth as previously estimated; confirm blood flow at the final point. Turn the
handle of the stopcock toward the infant. Gently tighten and knot the purse string,
leaving both ends of the suture long. Approximately 5 cm from the knot at the
base of the cord, make a square knot and then loop and tie the suture around the
catheter to help secure it in place, as shown in Figure 130.8B , part E. An
alternative is to suture in a purse string circumferentially around the umbilical
cord. Then tie the knot around the catheter to assist in maintaining it securely.
Also place tape on the abdominal wall as shown in the figure. Verify with an
abdominal radiograph that the tip of the catheter lies at the desired level.
Infuse solutions containing heparin (1 U/mL) unless contraindicated for
bleeding diathesis.

UMBILICAL VEIN CATHETERIZATION
Indications
To gain vascular access rapidly in a newborn with respiratory failure or
cardiovascular collapse. Venous catheterization is possible until approximately 2
weeks of age.

Complications
1. Infection
2. Embolization or thrombosis
3. Vessel perforation
4. Hemorrhage
5. Air embolus