Placement & Position of High-Lying Lines

UAC:

(Birthweight(kg) X 3) + 9 = Insertion Depth*

A recent study using a new formula for UAC placement in low birthweight infants (<1500 g) resulted in a reduction of post-xray catheter adjustments from 50% to 5%. (Wright, I.M. et al. PubMed.) The formula was: (birth weight(kg) x 4) + 7

UVC:

½UAC + 1 = Insertion Depth*

OR

(Birthweight(kg) X 1.5) + 5.5 = Insertion Depth*

*The centimeter marking closest to the umbilicus tells you how deep the line is inserted. Add an appropriate length for longer umbilical stumps.

Ideally, if lines are needed they are placed on the first day of life, however, lines have been successfully placed in babies a week old.

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Securing Lines

Secure lines (usually already sutured and placement verified) either by 1)creating a loop and covering with a transparent dressing, or, 2) creating a bridge with tape and looping through the bridge. Do not cover the umbilicus with a dressing unless pressure is needed to stop bleeding. Remove umbilical ties after bleeding is stopped to avoid skin necrosis.

A Word about UACs & UVCs

Umbilical Arterial Lines (UACs)

The two most common uses of UACs are invasive blood pressure monitoring and arterial blood sampling

Less common uses of UACs are fluid administration, exchange transfusions and cardiac catheterizations. Medication administration is not recommended particularly with vasoactive drugs, hyperosmolar solutions, hyper- and hypotonic solutions and high-flow rates. One study showed complication rates for the administration of Ampicillin and Gentamicin through UACs as 39% for high-lying catheters and 78% for a low-lying catheters. Note - sources did not say if the medications were administered through a filtered system. Complications included blanching, clots in catheters and pseudomembranous enterocolitis. Complication rates infusing TPN through UACs are similar to that of UVCs. (American Journal of Health-System Pharmacy 60(15):1569-1572, 2003. Survey of Medication Administration Through Umbilical Arterial and Venous Catheters. Medscape.

Umbilical Venous Lines (UACs)

The two most common uses of UVCs are fluid and drug administration. A low-lying UVC can quickly be placed in the delivery room when fluid rescusitation is critical.

Small-for-gestation infants with UVCs have over double the incidence of developing thrombi as their appropriately weighted peers. CDC recommends umbilical venous catheter removal at 14 days. The incidence of infection and complication is the similar between groups that have their UVC removed earlier (7 - 10 days) and a PICC line placed, and those that keep their UVCs in for longer periods of time (up to 4 weeks). (Pediatrics. July 2006;118:e25-e35. Medscape.