To provide rapid vascular access in neonates up to 2 weeks of age for resuscitation in which all other access attempts have failed

 To provide rapid administration of intravenous fluids, medications, and blood

CONTRAINDICATIONS

 None for the unstable newborn with respiratory failure or cardiovascular compromise

 Relative Contraindications

    Successful peripheral or central venous access

    Umbilical vein catheter (UVC) placement in newborns with omphalocele, gastroschisis, omphalitis, peritonitis, or necrotizing enterocolitis

    Cellulitis or impetigo of the abdominal skin

LANDMARKS

 The umbilicus consists of one large, thin-walled vein and two smaller, thick-walled arteries

 Picture the vessels as a face in which the arteries form the eyes, and the vein forms the mouth (FIGURE 91.1)

EQUIPMENT

 Personal protective equipment (face mask, eye protection, gown, sterile gloves)

 Cardiac monitor with pulse oximetry

 Antiseptic prep solution, sterile drapes, gauze pads, antibiotic ointment

 External heat source (i.e., radiant warmer or heat lamps)

 Umbilical catheter tray (if not available, then equipment listed below)

    Scalpel (No. 11 or 15)

    Small hemostat

    Needle holder

    Umbilical tape or silk suture (3-0 or 4-0) on straight or curved needle

    Size 5-French umbilical catheter

 A 10-mL saline-filled syringe

 Three-way stopcock

 Bag of saline solution

 Adhesive tape

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