Umbilical Catheters…
What are they?
Did you even know that they existed prior to having a baby in the NICU?
Fetal Circulation
To fully understand them, we need to go back a bit and talk about fetal circulation when the baby is inside the Mama. A fetus has 2 arteries and 1 vein that carry blood back and forth between the placenta and the fetus.
Highly oxygenated, nutrient-rich blood travels from the placenta and enters the fetal circulation through the one vein in the umbilical cord. The oxygenated blood travels through several different fetal shunts and the liver then flows throughout the fetus.
Since the placenta acts as the “fetal lungs” most of the blood bypasses the fetus’ lungs. Therefore, gas exchange occurs via the placenta. Since the lungs are collapsed, the resistance is high making the pulmonary pressure higher than the fetus’ systemic pressure.
The umbilical arteries then carry the deoxygenated, nutrient depleted blood from the fetus back to the placenta.
Circulation After Delivery
Your baby’s circulation changes once your baby undergoes several steps beginning with their first breath. Due to the new oxygen in the lungs and the infant breathing, the baby’s pulmonary pressure decreases. Once the cord is clamped, the baby’s systemic pressures increase and helps with more blood flow to the lungs.
Between the increased amount of oxygen and the increase in systemic pressure after birth, the previous fetal circulation changes to newborn circulation. The shunts previously used typically close shortly after birth.
Venous and Arterial Access
Although the cord is clamped at birth, the 1 vein and 2 arteries are still accessible and able to be used for venous and arterial access for your baby.
An umbilical venous catheter (UVC) can be inserted into your baby’s umbilical vein for the administration of IV fluids and medications. The UVC provides your baby with venous access to prevent the need for multiple peripheral IVs. Less PIVs means less needle sticks for your little one. Often times, UVC lines are eventually replaced with a peripherally inserted central catheter (PICC line) – which is a topic for a different day…
The NICU team may also decide to place an umbilical arterial catheter (UAC) in either of the umbilical arteries. UAC lines are used for frequent lab draws, to continuously monitor arterial blood pressures or at times for the infusion of fluids.
Both catheters are inserted under sterile technique by a member of the NICU team and their placement can only be verified by an X-Ray.
The Disadvantages of Umbilical Catheters
At times, the NICU team may not be able to fully access the vein or arteries in the umbilicus to centrally place the catheter. This can occur either due to the status of the umbilical cord or the anatomy of the baby.
The other unfortunate part of these catheters is that they can only remain in place for a limited amount of time before they need to be removed for the safety of your baby.
Catheter Line Maintenance
The lines will be sutured in place and secured based on the hospital’s protocol. To ensure they do not migrate, the NICU staff will keep a very close eye on both of the catheters.
Any IV tubing changes or blood draws should be done under sterile technique since the line is considered a central line.
Do to the importance of the lines not migrating as well as for the safety of your baby, each hospital may have different policies on whether or not you can hold or do kangaroo care with them in place. But, I strongly encourage you to still ask if you can hold your baby before assuming that you cannot.
Was this helpful?
I hope this explanation on UVC and UAC catheters has been valuable for you and not too confusing! The advances in Neonatology are constantly changing, but UVC and UAC lines have been around for years and remain a constant.
I’d love to hear if your infant had a UVC and/or UAC line. If so, were you able to hold them while they were in place?
