a procedure in which a radiopaque catheter is passed through an umbilical artery to provide a newborn with parenteral fluid, to obtain blood samples, or both, or through the umbilical vein for an exchange transfusion or the emergency administration of drugs, fluids, or volume expanders.
method Within 1 hour of insertion of the catheter, the position of the tip is validated by x-ray examination. The infant is maintained in a neutral thermal environment as parenteral fluids are delivered by an infusion pump. The rate of flow is checked hourly, and the IV bottle is never allowed to empty. All connections to the umbilical line are checked every 30 to 60 minutes, and only grounded electric equipment is used on or near the infant. At hourly intervals the young patient is repositioned, and the cardiac and respiratory rates are monitored; the axillary temperature is taken every 2 to 3 hours, and the pedal pulses are checked every 2 to 4 hours. The condition of the cord is observed every 2 to 3 hours for signs of infection such as redness, edema, or drainage at the catheter insertion site. The IV tubing is retaped when required, the cord dressing is changed, and antibiotic or antiseptic ointment is applied as ordered. If the umbilical line is displaced, pressure is quickly applied to the cord with a sterile 4 × 4-inch gauze, and an associate is delegated to notify the physician immediately. Fluid intake and output are measured. The infant is observed for oliguria or anuria; signs of vasospasm such as blanching, mottling, or darkening of the legs and absence of peripheral pulses; evidence of sepsis, hemorrhage, or oozing at the catheter insertion site; thromboembolism; and abdominal distension and vomiting, which may indicate necrotizing enterocolitis.
interventions The nurse provides ongoing care, monitoring the catheterized infant for any signs of complications, which are promptly reported. The family is included in the care of the infant as much as possible.
outcome criteria Umbilical catheterization can be an effective method of administering therapeutic fluids and agents or of obtaining diagnostic blood samples from a high-risk newborn, but great care is required in inserting and monitoring the tube.