Paeds · investigations-procedures-and-technology
Umbilical venous and arterial catheterisation
Also known as Umbilical venous catheter · Umbilical arterial catheter · UVC and UAC insertion · Umbilical line depth formula · Neonatal umbilical vessel cannulation
A fellowship approach to umbilical venous and arterial catheterisation in newborns covering the two vessel types and their courses, the high and low umbilical arterial catheter positions with high between T6 and T9 preferred over low at L3 to L4, the umbilical venous catheter target at T8 to T9 at the diaphragm, the Shukla birth-weight depth formula with umbilical arterial catheter length equal to three times birth weight in kilograms plus nine and umbilical venous catheter length equal to half that value plus one, catheter sizing of three point five French under 1500 grams and five French over 1500 grams, dwell limits of five days for the arterial line and fourteen days for the venous line, and the recognition and prevention of complications including malposition, portal vein and aortic thrombosis, lower-limb ischaemia, necrotising enterocolitis and line sepsis.
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Target exams
Red flags
- Lower-limb blanching, cyanosis, or mottling after umbilical arterial catheter insertion — vasospasm or thromboembolism that needs the line removed at once
- An umbilical venous catheter tip sitting in the right atrium or beyond — arrhythmia, pericardial effusion and tamponade, or liver parenchymal infusion injury
- An umbilical arterial catheter at a low L3 to L4 position when a high T6 to T9 position was intended — higher risk of renal, mesenteric and lower-limb ischaemia
- Persistent neonatal hypertension in a baby with an umbilical arterial catheter — renal artery thrombosis until proven otherwise
- Abdominal wall redness, purulent discharge, or cellulitis around the umbilical stump — omphalitis, which contraindicates line insertion and demands removal of any line present
- Feeds started or continued with a low-sitting umbilical arterial catheter, or bloody or blood-stained stools — mesenteric ischaemia and necrotising enterocolitis
- A line left in situ beyond its dwell limit — five days for an arterial line and fourteen days for a venous line — when no longer needed
Life stages
Care settings
Clinical exam formats
Board mappings
- Neonatal Medicine
- Procedural Skills and Patient Safety
- Current 2026 PREP curriculum — Learning Objective: Perform neonatal procedures safely and recognise their complications
- Current 2026 PREP curriculum — Learning Objective 2.2.1: Recognise, prioritise and manage an acutely ill infant, child or young person
- Renewed curriculum for first-year trainees from 2027 — Learning goal 6: Clinical management – essential general paediatrics
- Clinical Applications
- Medical Sciences
- Short Cases
- 1. Clinical: neonate requiring vascular access and monitoring
- 3. Safe and effective prescribing and procedural safety
- 7. Patient safety, including device-related harm and infection prevention
- Foundation of Practice (FOP)
- Theory and Science (TAS) — neonatal vascular anatomy and catheter mechanics
- Applied Knowledge in Practice (AKP)
- Communication
- History
- Clinical
- General Pediatrics Content Outline — Domain 8: Neonatology and Procedural Skills
- General Pediatrics Content Outline — Universal Task 4: Management and Treatment
- Patient Care 1: procedural skills in the neonate
- Patient Safety/Quality Improvement 1: device-related and catheter-associated infection prevention
- Systems-Based Practice 1: safe line insertion, dwell limits and removal
- Medical Expert
- Pediatrics: Core EPA #3 — Perform neonatal procedures
Overview & Definition
Picture a twenty-eight-week infant who needs arterial blood-gas monitoring and a reliable central line in the first hours of life, a term baby in shock who needs emergency venous access before a peripheral line is possible, and a neonate on the unit whose arterial line has been in for a week. Each of them turns on a different part of the same skill — choosing the right vessel, calculating the right depth, confirming the tip, and knowing when the line must come out. [1] [9]
The umbilical stump carries three vessels at birth: two umbilical arteries, which are thick-walled with a small round lumen, and one umbilical vein, which is thin-walled with a large oval lumen. The arteries return deoxygenated blood from the fetus to the placenta, while the vein carries oxygenated blood back, and after birth these channels stay open for only a short window — the arteries for a few days, the vein for up to a week — which is what makes them usable as a route to the central circulation. [9]
From the indication to a confirmed, safe line
- 1
1 · Confirm indication and exclude contraindications
Decide arterial versus venous access, and rule out omphalitis, omphalocele, gastroschisis, and necrotising enterocolitis.
- 2
2 · Calculate the depth and choose the catheter
Apply the Shukla formula, select 3.5 French under 1500 grams or 5 French over 1500 grams, and prepare full sterile precautions.
- 3
3 · Cannulate the correct vessel to the calculated depth
Identify the artery or vein, dilate gently, advance to depth, aspirate and flush, and secure with a suture bridge.
- 4
4 · Confirm the tip on radiograph
Take an AP and lateral film; the arterial line sits high at T6 to T9 or low at L3 to L4, the venous line at the diaphragm T8 to T9, and reposition any malposition.
- 5
5 · Monitor and remove on time
Watch for limb blanching and sepsis, add heparin to the arterial infusion, and remove at five days for arterial or fourteen days for venous, or sooner if needed.
References12ShowHide
- [1]Shukla H; Ferrara A Rapid estimation of insertional length of umbilical catheters in newborns American journal of diseases of children (1960), 1986.PMID 3728405
- [2]Lean WL; Dawson JA; Davis PG; Theda C; et al Accuracy of 11 formulae to guide umbilical arterial catheter tip placement in newborn infants Archives of disease in childhood. Fetal and neonatal edition, 2018.PMID 28818852
- [3]Verheij GH; te Pas AB; Smits-Wintjens VE; Sramek A; et al Revised formula to determine the insertion length of umbilical vein catheters European journal of pediatrics, 2013.PMID 23503982
- [4]Gupta AO; Peesay MR; Ramasethu J Simple measurements to place umbilical catheters using surface anatomy Journal of perinatology, 2015.PMID 25611793
- [5]Kieran EA; Laffan EE; O'Donnell CP Estimating umbilical catheter insertion depth in newborns using weight or body measurement: a randomised trial Archives of disease in childhood. Fetal and neonatal edition, 2016.PMID 26265678
- [6]Levit OL; Shabanova V; Bizzarro MJ Umbilical catheter-associated complications in a level IV neonatal intensive care unit Journal of perinatology, 2020.PMID 31911645
- [7]Barrington KJ Umbilical artery catheters in the newborn: effects of position of the catheter tip The Cochrane database of systematic reviews, 2000.PMID 10796375
- [8]Kempley ST; Bennett S; Loftus BG; Cooper D; et al Randomized trial of umbilical arterial catheter position: clinical outcome Acta paediatrica (Oslo, Norway : 1992), 1993.PMID 8477163
- [9]Marshall M Radiographic assessment of umbilical venous and arterial catheter tip location Neonatal network, 2014.PMID 24985114
- [10]Barone G; Piersigilli F; Pittiruti M Vascular access in the newborn: a position paper of Neonatal European Vascular Access Teams (NEVAT) European journal of pediatrics, 2026.PMID 41524806
- [11]Lin YJ; Liu YC; Huang HC; et al Echocardiographic determination of umbilical catheter tip location mitigates complications: a randomised controlled trial Children (Basel, Switzerland), 2025.PMID 41300627
- [12]Wright IM; Owers M; Wagner M The umbilical arterial catheter: a formula for improved positioning in the very low birth weight infant Pediatric critical care medicine, 2008.PMID 18679150