UMBILICAL VASCULAR CATHETERIZATION (1) [Autosaved].pptx

A ppt on techniques of UVC and UAC insertion..

1. Umbilical Line Insertion,Maintenance and Complications PRESENTER- Dr R K SHWETABH MODERATOR- Dr Abhishek Paul

2. S PECIFIC LEARNING OBJECTIVES Anatomy Indications and Contraindications Recomemnded Technique for catheter placement Complications Interesting Cases

3. Umbilical Venous Catheterization Indication: Emergency Vascular access Central Venous Pressure Monitoring Exchange transfusion Administration of TPN etc.

4. UMBILICAL VEIN PATHWAY

5. Contraindications Omphalocele Gastrochisis Omphalitis Peritonitis Vascular compromise NEC (Umbilical Vein Catherisation,Kewin Lewis,2022)

6. Depth of insertion MC used formula -Modified Shukla’s formula (3 × weight [kg]+ 9)/2 Other formula: i . Gomella’s formula: Measurement of distance from the umbilicus to the xiphisternum and adding 1 cm ii. Vali’s formula: Measurement from the umbilicus to the mid-xiphoid-to-bed distance on the lateral aspect of the abdomen

7. Other formula iii)Shoulder-umbilical length X 0.66+ Umbilical stump length Iv)For exchange transfusion/emergency vascular assess-Catheter advanced only till good blood flow obtained(2-5 cm) v)Dunn Normogram

8. Position of catheter Preffered position- 0.5-1 cm above level of diaphragm(between T9-T10) Recommended durartion —14 days Catheter size- Birth weight<1.5 kg 3.5 F Birth weight >1.5 kg 5F

9. Complications Infection(Most Common)- Sepsis,Cellulitis,Omphalitis,Liver abscess Line malposition- Arrhythmia,Cardiac tamponade,portal vein thrombosis Blood loss Embolism Catheter breakage

10. Umbilical Artery Catheterisation Umbilical artery catheterization Frequent measurement of arterial blood gases Continuous monitoring of arterial blood pressures Exchange blood transfusion ( isovolumetric ) Angiography

11. UMBILICAL ARTERY PATHWAY

12. Length of insertion (ii) Wright’s formula <32 weeks/<1.5 kg—(4 ×birth weight [kg]) + 7; and (iii) Shukla’s formula for babies >32 weeks/>1.5kg—(3 × weight) + 9.

13. Dunn’s formula—nomogram using shoulder umbilical length

14. Positions of UAC UAC 1. High position - Tip of catheter lies between T6 and T9 vertebrae. High position is preferred due to lower incidence of vascular complications*. 2. Low position - Tip of catheter lies between L3 and L4 Vertebrae (Umbilical Artery Catheterisation- Vikramaditya Dumpa,2022)

15. Catheter Size and Duration Duration-7 days Catheter size Birth weight <1.2 kg 3.5 F Birth weight>1.2 kg 5 F

16. Complications 1)Blanching of leg-Due to vasospasm MC complication Generally transient Warm opposite leg No improvement-Remove catheter Topical nitroglycerine (2%) can be used

17. Complications Thrombus Trauma Line migration Catheter breakage Infection

18. IDENTIFICATION UMBILICAL ARTERY UMBILICAL VEIN 2 in number(usually) 1 in number Location-1 and 7 0 clock 6 o clock Thick wall,small lumen Thin wall,slit like lumen(large caliber ) Generally don’t bleed spontaneously Oozing of blood may be present

19. equipment Sterile gown,gloves,cap,mask Saline or heparinized flushing Skin prep and drape or towels solution Sterile 4 X4 gauze Iris scissors Three way stopcock Mosquito hemostats 5-10 ml syringe Umbilical tie ,suture Scalpel blade

20. IMAging Correct position of UV catheter.

21. UV catheter in left branch of portal vein.

22. UV catheter in right branch of portal vein. Air has been introduced into the liver.

23. UV catheter has entered the left atrium via the foramen ovale .

24. Normally placed UAC.

25. UAC in femoral artery.

26. High UAC.

27. Ultrasound imaging Proper UVC (A) and UAC (B) imaging and positioning. The UVC leaving the ductus venosus (C); the UAC, crossing the celiac trunk and superior mesenteric artery (D).

28. Tip localisation

29. Interesting case

30. Case 2

31. Case Details Term baby,MAS UVC inserted on Day 2 of life Removed on day 5 of life While removal UVC was cut by blade while cutting suture

32. Case 2

33. Case 3

34. Case 3

35. Case 4

36. Case 5