An umbilical line is a

catheter In medicine, a catheter ( ) is a thin tubing (material), tube made from medical grade materials serving a broad range of functions. Catheters are medical devices that can be inserted in the body to treat diseases or perform a surgical procedure. ...

that is inserted into one of the two

arteries An artery () is a blood vessel in humans and most other animals that takes oxygenated blood away from the heart in the systemic circulation to one or more parts of the body. Exceptions that carry deoxygenated blood are the pulmonary arteries in ...

or the

vein Veins () are blood vessels in the circulatory system of humans and most other animals that carry blood towards the heart. Most veins carry deoxygenated blood from the tissues back to the heart; exceptions are those of the pulmonary and feta ...

of the

umbilical cord In Placentalia, placental mammals, the umbilical cord (also called the navel string, birth cord or ''funiculus umbilicalis'') is a conduit between the developing embryo or fetus and the placenta. During prenatal development, the umbilical cord i ...

. Generally the UAC/UVC (Umbilical Artery Catheter/Umbilical Vein Catheter) is used in

Neonatal Intensive Care Unit A neonatal intensive care unit (NICU), also known as an intensive care nursery (ICN), is an intensive care unit (ICU) specializing in the care of ill or premature newborn infants. The NICU is divided into several areas, including a critical c ...

s (NICU) as it provides quick access to the central circulation of premature infants. UAC/UVC lines can be placed at the time of birth and allow medical staff to quickly infuse fluids, inotropic drugs, and blood if required. It is sometimes used in term or near-term newborns in whom the umbilical cord stump is still connected to the

circulatory system In vertebrates, the circulatory system is a system of organs that includes the heart, blood vessels, and blood which is circulated throughout the body. It includes the cardiovascular system, or vascular system, that consists of the heart ...

. Medications, fluids, and blood can be given through this catheter and it allows monitoring of

blood gas A blood gas test or blood gas analysis tests blood to measure blood gas tension values and blood pH. It also measures the level and base excess of bicarbonate. The source of the blood is reflected in the name of each test; arterial blood gases ...

ses and withdrawing of

blood sample In medicine, sampling is gathering of matter from the body to aid in the process of a medical diagnosis and/or evaluation of an indication for treatment, further medical tests or other procedures. In this sense, the sample is the gathered matter ...

s. ''Transumbilical catheter intervention'' is also a method of gaining access to the heart, for example to surgically correct a

patent ductus arteriosus Patent ductus arteriosus (PDA) is a medical condition in which the ''ductus arteriosus'' fails to close after childbirth, birth: this allows a portion of oxygenated blood from the left heart to flow back to the lungs from the aorta, which has a h ...

Complications

The complications of umbilical lines are similar to those of

central venous catheter A central venous catheter (CVC), also known as a central line (c-line), central venous line, or central venous access catheter, is a catheter placed into a large vein. It is a form of venous access. Placement of larger catheters in more centr ...

s mainly

infection An infection is the invasion of tissue (biology), tissues by pathogens, their multiplication, and the reaction of host (biology), host tissues to the infectious agent and the toxins they produce. An infectious disease, also known as a transmis ...

s such as

neonatal sepsis Neonatal sepsis is a type of neonatal infection and specifically refers to the presence in a newborn baby of a bacterial blood stream infection (BSI) (such as meningitis, pneumonia, pyelonephritis, or gastroenteritis) in the setting of fever. Ol ...

and

thrombosis Thrombosis () is the formation of a Thrombus, blood clot inside a blood vessel, obstructing the flow of blood through the circulatory system. When a blood vessel (a vein or an artery) is injured, the body uses platelets (thrombocytes) and fib ...

. The most common organisms causing these infections are coagulase negative staphylococci such as ''

staphylococcus epidermidis ''Staphylococcus epidermidis'' is a Gram-positive bacterium, and one of over 40 species belonging to the genus ''Staphylococcus''. It is part of the human flora, normal human microbiota, typically the skin flora, skin microbiota, and less commonl ...

'' To avoid catheter-related bloodstream infections checklists and care bundles focused on strict hygiene routines are often recommended.

Umbilical arterial catheter

The position of an umbilical arterial catheter is confirmed on plain film. From the umbilicus, the umbilical arterial catheter dives inferiorly and joins the right or left

internal iliac artery The internal iliac artery (formerly known as the hypogastric artery) is the main artery of the pelvis. Structure The internal iliac artery supplies the walls and viscera of the pelvis, the buttock, the reproductive organs, and the medial com ...

before turning superiorly to the

common iliac artery The common iliac artery is a large artery of the abdomen paired on each side. It originates from the aortic bifurcation at the level of the 4th lumbar vertebra. It ends in front of the sacroiliac joint, one on either side, and each bifurcates ...

and

aorta The aorta ( ; : aortas or aortae) is the main and largest artery in the human body, originating from the Ventricle (heart), left ventricle of the heart, branching upwards immediately after, and extending down to the abdomen, where it splits at ...

. Appropriate positioning of the catheter tip can be either 'high' or 'low.' The high range is judged relative to

thoracic vertebra In vertebrates, thoracic vertebrae compose the middle segment of the vertebral column, between the cervical vertebrae and the lumbar vertebrae. In humans, there are twelve thoracic vertebra (anatomy), vertebrae of intermediate size between the ce ...

, and is between T6 and T10, to avoid major aortic branches. The low range is relative to

lumbar vertebra The lumbar vertebrae are located between the thoracic vertebrae and pelvis. They form the lower part of the back in humans, and the tail end of the back in quadrupeds. In humans, there are five lumbar vertebrae. The term is used to describe the ...

, and is between L3 and L5. The lower position may be associated with a higher rate of vascular complications such as thrombosis or

vasospasm Vasospasm refers to a condition in which an arterial spasm leads to vasoconstriction. This can lead to tissue ischemia (insufficient blood flow) and tissue death (necrosis). Along with physical resistance, vasospasm is a main cause of ischemi ...

Umbilical venous catheter

Anomalous positioning of the umbilical venous catheter occurs frequently because it is usually inserted without imaging guidance, and confirmed after placement on subsequent plain film, occurring in approximately 50% of first attempts. From the

umbilical vein The umbilical vein is a vein present during fetal development that carries oxygenated blood from the placenta into the growing fetus. The umbilical vein provides convenient access to the central circulation of a neonate for restoration of blood vo ...

at the

umbilicus Umbilicus may refer to: *The navel or belly button *Umbilicus (mollusc), a feature of gastropod, Nautilus and Ammonite shell anatomy *Umbilicus (plant), ''Umbilicus'' (plant), a genus of over ninety species of perennial flowering plants *Umbilicus ...

, the catheter curves superiorly and to the right, joining the left

portal vein The portal vein or hepatic portal vein (HPV) is a blood vessel that carries blood from the gastrointestinal tract, gallbladder, pancreas and spleen to the liver. This blood contains nutrients and toxins extracted from digested contents. Approxima ...

, passing through the patent

ductus venosus In the fetus, the ''ductus venosus'' (''"DV"''; Arantius' duct after Julius Caesar Aranzi) shunts a portion of umbilical vein blood flow directly to the inferior vena cava. Thus, it allows oxygenated blood from the placenta to bypass the liver. ...

to the

inferior vena cava The inferior vena cava is a large vein that carries the deoxygenated blood from the lower and middle body into the right atrium of the heart. It is formed by the joining of the right and the left common iliac veins, usually at the level of the ...

and

right atrium The atrium (; : atria) is one of the two upper chambers in the heart that receives blood from the circulatory system. The blood in the atria is pumped into the heart ventricles through the atrioventricular mitral and tricuspid heart valves. ...

. Appropriate UVC tip position is in the high inferior vena cava to the low right atrium, typically within 1 cm of the diaphragm. If the UVC tip is proximal to ductus venosus it can lead to administration of intravenous fluids into the portal system, with potential portal vein thrombosis, or, in cases of TPN administration, a TPN

abscess An abscess is a collection of pus that has built up within the tissue of the body, usually caused by bacterial infection. Signs and symptoms of abscesses include redness, pain, warmth, and swelling. The swelling may feel fluid-filled when pre ...

References

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