Pediatric emergency medicine trisk 4338 4338

Equipment
Umbilical tape or 3-0 silk suture on straight or curved needle, antiseptic solution
(povidone-iodine), sterile gauze pad, drapes, mask, gown, gloves, small curved
hemostat.
Sterile scalpel and no. 11 or 15 blade, iris scissors, 5Fr umbilical catheter threeway stopcock, 10-mL syringe with normal saline, infusing solution.
Procedure
The umbilical vein is preferred for vascular access during neonatal resuscitation
because the vessel is readily located and cannulated. Catheterizing the umbilical
vein is generally much easier than catheterizing the umbilical artery.
Place the newborn supine and restrain the extremities as necessary. The
newborn should be under a radiant warmer, and heart rate and pulse oximetry
should be monitored throughout the procedure. Prepare the equipment. Attach a
5Fr umbilical catheter to a three-way stopcock and a saline-filled syringe. Prime
the catheter with normal saline. Wearing mask, gown, and gloves, cleanse the
umbilical cord and the abdomen from the xiphoid process to the pubic symphysis
with povidone-iodine solution and allow to dry. Hold the sterile umbilical catheter
over the infant to measure the vertical distance from the lateral aspect of the
clavicle to the umbilicus. The catheter will be advanced into the vein 60% of this
distance, beginning at the skin surface, to avoid direct infusion of medications
into the liver. At the base of the umbilical cord, loosely tie an umbilical tape or
insert 3-0 silk suture around the cord to make a purse string. Cut the cord 1 to 2
cm from the abdominal wall. Locate the vein orifice (larger with thinner wall
compared to the arteries) and remove any visible solid clot with fine forceps.