UTMB RESPIRATORY CARE SERVICES
PROCEDURE - Entry into Umbilical Artery Catheter
Policy 7.3.43
Page 1 of 4
Entry into Umbilical Artery Catheter
Effective:
Reviewed:
Formulated: 10/79
10/24/94
5/31/05
Entry into Umbilical Artery Catheter
Purpose
To standardize the proper method of obtaining blood samples from an
umbilical artery catheter.
Scope
Respiratory Care Services provides appropriate training for all practitioners
withdrawing blood Samples to meet minimum criteria.
Accountability/Training
 Licensed Respiratory Care Practitioners trained in Pediatrics employed
by Respiratory Care Service.
 The practitioner will have a complete understanding of the entire
procedure with an awareness of indications, contraindications and
complications of such a procedure. He/she will be able to demonstrate
the proper technique for entry under supervision. After completing the
certification per Respiratory Care Services policy, his/her name will be
added to the roster of those eligible to do the procedure by the Program
Manager, Respiratory Care Service, as maintained in the Policy and
Procedure Manual.
Physician's
Order
Arterial Blood Gases and laboratory work will be drawn as ordered by M.D.
or as a component for routine procedure or ventilator protocol.
Indications
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Contraindications
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Goals
Umbilical artery lines are entered for removal of blood for monitoring
of laboratory work and arterial blood gases.
Umbilical arterial lines are entered for the administration of intravenous
fluids and medications.
Any time an arterial line is entered, sterile technique should be
maintained.
Care should be taken to prevent blood clots or air emboli from entering
the patient.
The umbilical artery line should be maintained as a closed circuit to
prevent the loss of blood or intravenous fluids.
Signs of complications (i.e.: leg blanching, discoloration, decreased
peripheral pulses, improper position of catheter) indicating that infusion
or withdrawal through the catheter may cause or further decrease
circulation to an extremity.
An infant with an already depleted blood volume.
The therapist will be able to properly remove the appropriate amount of
blood for studies without complications.
Continued next page
UTMB RESPIRATORY CARE SERVICES
PROCEDURE - Entry into Umbilical Artery Catheter
Policy 7.3.43
Page 2 of 4
Entry into Umbilical Artery Catheter
Effective:
Reviewed:
Formulated: 10/79
Equipment
Needed
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10/24/94
5/31/05
3 cc sterile dry syringe for clearing line
1 cc sterile syringe with dead space filled with 1000 units per cc of
heparin
1 cc syringe for drawing lab work
1 cc syringe of normal saline for flush (This syringe is placed on the
stopcock at the beginning of each shift).
Procedure
Step
Action
1
Verify Physician's Order and Patient identification. Evaluate
infant for feasibility of drawing ABG.
2
Assemble Equipment.
3
Wash hands. Wear gloves.
4
Check position of stopcock, making sure it is closed to the
flush syringe.
5
Remove flush syringe, cap and set aside.
6
Place 3 cc drying syringe on stopcock.
7
Turn stopcock off to intravenous fluids
8
Draw back 2-2½ cc of blood to clear line and obtain an
uncontaminated blood sample.
9
One-fourth turn stopcock off. Remove syringe, cap and set
aside
10
Place appropriate syringe on stopcock.
11
Turn stopcock off to intravenous fluids and draw blood
sample needed.
a. 0.3 cc for ABG in heparinized TB syringe (flush syringe
with 1000u Heparin leaving a tiny amount in dead space
of syringe).
b. Appropriate amount for laboratory work in proper
vacutainer tubes.
12
Remove cap from the syringe of blood drawn earlier to clear
the line. Replace this into stopcock.
Continued next page
UTMB RESPIRATORY CARE SERVICES
PROCEDURE - Entry into Umbilical Artery Catheter
Policy 7.3.43
Page 3 of 4
Entry into Umbilical Artery Catheter
Effective:
Reviewed:
Formulated: 10/79
10/24/94
5/31/05
Procedure
Continued
Step
Assessment
of Outcome
Action
13
One-fourth turn stopcock and remove sample syringe.
For ABG's prepare for transport -Remove air bubbles and ice sample.
For laboratory -- Place in appropriate vacutainer and label.
14
Remove cap from the syringe of blood drawn earlier to clear
the line. Replace this into stopcock
15
Turn stopcock off to intravenous fluids, draw slightly back
on syringe and flick to remove air bubbles. Then slowly reinfuse blood. Observe line to make sure no air or clots are
infused.
16
17
One-fourth turn stopcock OFF, remove syringe.
18
Turn stopcock off to intravenous fluids, draw back slightly
on syringe and flick any air bubbles to top, using as little
flush as possible to clear line of blood.
19
Return stopcock off to flush syringe, leaving I.V. open.
20
Make sure all connections are tightly secure and that the
stopcock is open to intravenous infusions.
21
Make sure all connections are tightly secure and that the
stopcock is open to intravenous infusions.
22
Observe infant for any adverse reaction to the procedure.
23
Wash hands.
24
Chart the amount of blood withdrawn, keeping a running
total. The amount of flush solution used will be added to the
cumulative total of fluid intake.
Remove cap from flushing syringe, place in stopcock.
Obtaining the blood sample needed without complications occurring.
Continued next page
UTMB RESPIRATORY CARE SERVICES
PROCEDURE - Entry into Umbilical Artery Catheter
Policy 7.3.43
Page 4 of 4
Entry into Umbilical Artery Catheter
Effective:
Reviewed:
Formulated: 10/79
Infection
Control/
Safety
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Documentation
10/24/94
5/31/05
The umbilical arterial catheter should be maintained as a sterile infusion
line. Good hand washing technique is IMPERATIVE.
The arterial line should be observed at all times to maintain a closed
system to:
Prevent loss of blood
Prevent loss of I.V. fluids
Prevent air embolisms.
Maintain patency of line.
Follow procedures as outlined Healthcare Epidemiology Policies and
Procedures: #2.24 Respiratory Care Services.
http://www.utmb.edu/policy/hcepidem/search/02-24.pdf
Chart on RCS Flow sheet, treatment card per RCS Policies # 7.1.1 and #
7.1.2 and on the nursing flow sheet.
Correspond- UTMB Nursing Practice Standards, Umbilical Artery/Vein Catheter, Policy
#7.11.31. http://www.utmb.edu/policy/nursing/search/07%2D11%2D31.pdf
ing Policies
References
AARC Clinical Practice Guidelines; Sampling For Arterial Blood Gas
Analysis. Respiratory Care. 1992; 37:913-917.
Michael P Czervinske, RRT and Sherry L Barnhart, AS, RRT Perinatal and
Pediatric Respiratory Care, 2nd Edition W. B. Saunders 2003
M, Beckley SL, Harris Garibaldi JM, et al. Umbilical Cord Blood Gas
Analysis at the Time of Delivery. Midwifery. 1996; 12:146-50.
Riley RJ, Johnson JW. Collecting and analyzing cord blood gases. Clinical
Obstetric Gynecology. 1993; 36:13-23
Weibley RE, Riggs CD. Evaluation of an Improved Sampling Method For
Blood Gas Analysis From Indwelling Arterial Catheters. Critical Care
Medicine 1989; 17:803-5.