Pediatric emergency medicine trisk 4341 4341

FIGURE 130.8 A. Anatomy for umbilical vessel catheterization. B. Umbilical artery
catheterization. C. Umbilical vein catheterization.

Gently grasp the umbilical vein catheter about 2 cm from the tip with either a
small clamp or your gloved fingers ( Fig. 130.8C ). Introduce the catheter tip into
the umbilical vein. Apply gentle pressure and advance the catheter through the
venous lumen. The catheter is inserted until blood flows freely. This generally
occurs when the catheter tip is just beyond the junction of the umbilicus and the
abdominal wall. Advance the catheter to the previously estimated depth.
Tighten the umbilical tape or the purse string suture. Tape the catheter in place
to further secure it. It is important to confirm location of the catheter tip with an
x-ray. The umbilical vein catheter is usually withdrawn at the end of resuscitation
to minimize the danger of infection or portal vein thrombosis; therefore, it is
generally not necessary to suture this line in place.

INTRAOSSEOUS INFUSION
Indications
Emergency vascular access. Favored if intravenous access cannot be rapidly
obtained in life-threatening situations.

Complications
1. Extravasation of fluids or medications into subcutaneous tissue
2. Subcutaneous abscess, osteomyelitis, and bacteremia
3. Physeal injury or fracture
4. Fat embolus