UnIT.3:.UMBILICAL.CATHeTeRS
135
Skill Unit
inserting and Managing Umbilical Catheters
This skill unit will teach you how to insert umbilical arterial and venous catheters. Not every-
one actually will be required to learn and practice umbilical catheterization. However, everyone
should read this unit and attend a skill session to learn the equipment and sequence of steps to
assist effectively with umbilical catheterization.
The staff members who will be asked to master all aspects of this skill will need to demonstrate
each of the following steps correctly:
1. Restrain and measure “baby” for catheter insertion.
2. Collect the equipment and prepare the “sterile” tray.
3. Prepare catheter, stopcock, and heparin solution.
4. Cleanse the umbilical cord and surrounding skin; loosely tie umbilical tape around stump.
5. Cut cord to appropriate length.
6. Identify umbilical vessels.
7. Dilate umbilical artery and insert catheter. (You also may be asked to demonstrate venous
catheterization.)
8. Check blood return and flush catheter with heparinized solution; turn stopcock off to the
catheter.
9. Suture the catheter in place (or temporarily tape in place until location is confirmed by x-ray).
10. Tape catheter in place after x-ray taken, catheter location confirmed, and catheter sutured
in place.
11. Begin infusion or maintain catheter with heparin lock.
12. Use sterile technique and standard precautions throughout the procedure.
13. Illustrate the techniques to stop bleeding from an umbilical artery and from the umbilical vein.
The staff members who will be asked to master the assistant components of this skill will need
to demonstrate each of the following steps correctly:
1. Restrain “baby” for catheter insertion.
2. Collect the equipment and prepare the “sterile” tray.
3. Hold the distal section of cord in an elevated position until it is cut off.
4. Hold instruments to stabilize the umbilical cord and/or expose the artery or vein for cath-
eterization, as needed by the person inserting the catheter.
5. Tape catheter temporarily until placement is confirmed by x-ray (unless catheter was ini-
tially sutured in place).
6. Tape catheter in place after x-ray taken, catheter location confirmed, and catheter sutured in
place.
7. Begin infusion or maintain catheter with heparin lock.
8. Use sterile technique and standard precautions.
9. Illustrate the techniques to stop bleeding from an umbilical artery and from the umbilical vein.
In addition to the practice session(s) scheduled by your coordinators, a special joint physician-
nurse practice session may be arranged for nurses and perinatal care physicians in your hospital.
Note: The graph that accompanies Step 9 for umbilical arterial catheters and the illustration that
accompanies Step 27 for umbilical venous catheters in this skill unit are adapted with per-
mission from Klaus MH, Fanaroff AA. Care of the High-Risk Neonate. Philadelphia, PA:
WB Saunders Co; 2001.
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