In this post I embed the YouTube video “Emergency Umbilical Venous Line” from EM:RAP, 7:22, June 5, 2023.
An umbilical venous line can be place within the first 10 days of life. The supplies you need include: sterile gloves, sterile drape, antiseptic solution, 11-blade scalpel, umbilical tape, hemostat or forceps, a 5-French umbilical line or feeding tube, a saline-filled syringe connected to a 3-way stopcock, and tape.
Preparation:
First, use antiseptic solution to clean the umbilical cord and surrounding skin. Drape the patient. Wrap the umbilical tape at the base of the umbilicus and tie a loose knot that can be secured once the procedure is complete. Avoid making it too tight or you will not be able to advance the umbilical line. A suture can be used if umbilical tape is unavailable.
Placing the Line:
Cut the umbilical cord 1-2 cm from the base using a hemostat or forceps to brace the distal portion of the cord.
Examine the remaining umbilical cord for the two umbilical arteries and one umbilical vein (it looks like two eyes and a mouth). There may be clots in the vein that need to be removed. Forceps can be used to dilate the vein.
Prepare the umbilical line (or feeding tube) by flushing it with saline. Insert the line into the umbilical vein. You can use forceps to pull out on the vein and upwards on the umbilicus.
An assistant should aspirate the line as it is being inserted to confirm placement.
Avoid advancing the line too deeply as it can enter the portal circulation and cause liver injury. Once blood is aspirated from the line, only insert it 1 cm further and then stop.
The total depth of the line should not be more than 4-5 cm. If you have not aspirated blood back at this point you may be in a false lumen and should remove the line and attempt re-insertion.
Secure the Line:
Start by securing the knot in the umbilical tape (or suture) at the base of the umbilicus.
Use the H-tape method shown to tape the line to the baby.
Line placement is confirmed clinically and it can be used immediately, without x-ray confirmation.
