Umbilical artery catheters - routines?

[Stefan Johansson]

Dear all,
in our units most extremely preterm infants get umbil artery catheters (UACs), high position, and we tend to keep those for quite many days. In the most immature infants (23-24 weeks), sometimes up to 10-12 days, but usually we take it away at the end of the first week of life.
We place peripheral radial artery catheters if those infants deterioate later (sepsis etc).
Although we hardly see complications such as distal gangrene och symptomatic aortic thrombosis, I have a feeling that this practise of keeping UACs for many days is different from the routines in other units.

What is your routines/protocols for UACs?

[manberbenitez]

dear stefan
we leave the arterial catheters only 5 days, there are reports of hyperreninemic hypertension ( usually low catheters).We use it high.

your friend
manuel

[Joskumaria]

In our unit, we don`t use umbilical catheters at all. I presume that our doctors think it`s a little bit "old fashion -way". And I don´t quite frankly understand why.
Babys get a peripheral radial artery catheter and other peripheral lines for TPN and medicins. A neonate will get a UAC if the doctor won`t get any other line. And if that`s the case, they want to take the UAC away as soon as possible and replace it with peripheral line.

From my point of view as a NICU nurse, UACs are better and safer when nursing a baby. Plus you don`t have to cause pain to small baby when placing them. So my thougts are very much based on the NIDCAP.

RN Johanna from Finland

[T.Roberts RNC]

I am also a NICU nurse. We leave our UACs in place as long as we need them and they continue to function properly. We prefer high placement. We will use PAL if UAC becomes unusable or if baby develops need for the line after the umbilicus is dry. We have many fewer complications/line malfunctions/displacements with UACs.

[Hans Joergen]

In our NICU the preterm infants (including 24+ weeks) needing artery catheters normaly get a peripheral radial artery catheter. Very seldom is a UAC used, only if there is dificulties with peripheral lines. To my knowledge there have not been any complications. We keep it as long as needed, normaly 5-6 days.

Dr Hans Joergen Guthe
Childrens Department
Haukeland University Hospital
Bergen, Norway

[sudershan.kumari]

The umbilical arterial catheter is used only for about 5-6 days by that time most term babies are off ventilation. Also i have a feeling that infection rate increases if along with sepsis we keep catheters for longer than 7 days. Peripheral arteial line is also used frequently in vlbw babies.Complications are very rare, the catheter is removed at first suspicion . However umbilical venous catheter may be placed for a longer time if getting veins is a problem .as we start trophic feeds from day 2 ,need for pareneral nutriioin is much less with us

[doc4tots]

I suppose the 'right' answer is as long as it's needed. But what defines that? In a very low birth weight infant is the risk of complications of the UAC outweighed by the risk of frequently sticking an infant for blood work?

[holliesmama]

In our NICU the preterm infants (including 24+ weeks) needing artery catheters normaly get a peripheral radial artery catheter. Very seldom is a UAC used, only if there is dificulties with peripheral lines. To my knowledge there have not been any complications. We keep it as long as needed, normaly 5-6 days.

Dr Hans Joergen Guthe
Childrens Department
Haukeland University Hospital
Bergen, Norway

why isn't the UAC/ UVC your first choice of access? from what I have experienced, it is more stable than a PAL for sampling, and the uvc far more secure than repeated peripheral lines, especially for use with TPN. I know they may not last awhile, but i do feel more secure with this mode of access. just my two pennys worth!
arlene.

[Rahmi]

I do not prefer to keep umbilical cathaters ( high level) after 6 or 7 days. But rarely it lasted 12 days. What is your experience regarding maximum duration?

[pooperscooperrn0624]

Ideally we like to remove umbilical cathers within a week. However, with an unstable VLBW infant we have left them in several weeks while culturing for infection.

[bittybabygrower]

We use the UAC for up to 10 days and the double lumen UVC for as long as we need or until we can get central access per PICC line or CVL. In extreme cases we will put our TPN thru the UAC if there is no central line.

[lovely]

We use the UAC for up to 10 days and the double lumen UVC for as long as we need or until we can get central access per PICC line or CVL. In extreme cases we will put our TPN thru the UAC if there is no central line.

how is your infection rate with picc lines, how often you change the dressing?how do you access picc line for medication administration?Any tip to prevent 100% infection? are you using chlorprep for skin prep for picc insertion?

[nicurn2083]

I am not nurse of our exact infection rate, I know it is not really high. When our picc lines are first inserted, chlorprep is used. Then all picc dressing are changed after the first 72 hours with a chlorprep cleaning before the new dressing is placed. After the first dressing change, we only change the dressing if it becomes non-intact. This seems to be helping. Also our NNP's inspect all picc lines every day to ensure that the dressings are intact. Hope this helps
Jennifer Tucker BSN, RN
Minneapolis, MN

[lovely]

Thankyou Jennifer for the input.I would like to know more about the care and maintainance of the picc line.We use chlorprep in our unit for picc insertion.We change dressing only if needed.After 15 days we replace the picc line.our infection rate is very low.I am working towards no infection at all.Any suggestions?

[bittybabygrower]

We recently instituted the central line and handwashing bundles from IHI.org Our infection rates had been high but are on the decline now that we do everything strictly aseptic. We use stopcocks on our lines so that we are never opening any ports. We use chloraprep for insertion and only the first dressing is changed 24 hours later, and then only as needed after that. We change our lines under sterile technique also. When lines are being placed, we close off the pod and everyone in the room has to be masked until that line is covered, this includes UAC insertions until the sterile field is taken down. Good Luck!!!

[carolinavillegas]

The umbilical arterial and venous catheter is used only for 7 days by that time most term babies are off ventilation. Also i have a feeling that infection rate increases if along with sepsis we keep catheters for longer than 7 days.
Used only in prematures with SDR for monitorition

Dra, Villegas

[lovely]

Dear Caroline,

In our NICU we start Vit.A on admission for any babies weighing less than 1250gms at birth every Monday, Wed, and Friday for 4 weeks.

[sameera_reddy]

In our unit we secure UAC'S only in very sick neonates.We get rid of them as early as possible at the earliest phase of weaning from ventilator.One more reason why we get rid of them is because we start trophic feeds early and we are worried about NEC if we feed the babies on these catheters
Dr.Sameera Reddy
Division Of Neonatology
Manipal Hospital,
Bangalore,India

[Sam260174]

Never heard or read anybody giving TPN through the UAC!!!!!!!!!!!!!!!!!!!!!!

[Sam260174]

What is the evidence of UAC in situ and high risk of NEC .Is it your personal observation.
Cochrane review on this suggests no xcorrelation between the two.

Samridh nagar MD DNB
RACP advanced trainee neonatal medicine
Sydney Australia

[Stefan Johansson]

Never heard or read anybody giving TPN through the UAC!!!!!!!!!!!!!!!!!!!!!!
We do!

We use the central line for TPN that is available. Of course we prefer a percutaneous long-line catheter, but in sick premies for example, the UAC is commonly used.

[feraszaman]

Never heard or read anybody giving TPN through the UAC!!!!!!!!!!!!!!!!!!!!!!

We do if UVC went east or south.. Or if infant is so edematous and hard to place a PICC..

[feraszaman]

Today I was flipping thru "atlas of the newborn" and looked at many photos of gangrenes in the Lowe extremities secondary to arterial thrombosis or wrong placement. Somehow I decided to take out the UAC as soon as possible..(I do keep them for 5-7days usually)
It was scary stuff !!