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.

high12 referencesUpdated 17 July 202624 min readVerification in progress

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Target exams

RACP General PaediatricsRACP DWERACP DCERCPCH Progress+MRCPCH TheoryMRCPCH ClinicalABP General PediatricsACGME PediatricsRCPSC Pediatrics

Red flags

Lower-limb blanching, cyanosis, or mottling after umbilical arterial catheter insertion — vasospasm or thromboembolism that needs the line removed at onceAn umbilical venous catheter tip sitting in the right atrium or beyond — arrhythmia, pericardial effusion and tamponade, or liver parenchymal infusion injuryAn 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 ischaemiaPersistent neonatal hypertension in a baby with an umbilical arterial catheter — renal artery thrombosis until proven otherwiseAbdominal wall redness, purulent discharge, or cellulitis around the umbilical stump — omphalitis, which contraindicates line insertion and demands removal of any line presentFeeds started or continued with a low-sitting umbilical arterial catheter, or bloody or blood-stained stools — mesenteric ischaemia and necrotising enterocolitisA 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

fetalneonateinfant

Care settings

delivery-roomnicupicuwarded-acuteretrieval

Clinical exam formats

written-only

Board mappings

Neonatal MedicineProcedural Skills and Patient SafetyCurrent 2026 PREP curriculum — Learning Objective: Perform neonatal procedures safely and recognise their complicationsCurrent 2026 PREP curriculum — Learning Objective 2.2.1: Recognise, prioritise and manage an acutely ill infant, child or young personRenewed curriculum for first-year trainees from 2027 — Learning goal 6: Clinical management – essential general paediatricsClinical ApplicationsMedical SciencesShort Cases1. Clinical: neonate requiring vascular access and monitoring3. Safe and effective prescribing and procedural safety7. Patient safety, including device-related harm and infection preventionFoundation of Practice (FOP)Theory and Science (TAS) — neonatal vascular anatomy and catheter mechanicsApplied Knowledge in Practice (AKP)CommunicationHistoryClinicalGeneral Pediatrics Content Outline — Domain 8: Neonatology and Procedural SkillsGeneral Pediatrics Content Outline — Universal Task 4: Management and TreatmentPatient Care 1: procedural skills in the neonatePatient Safety/Quality Improvement 1: device-related and catheter-associated infection preventionSystems-Based Practice 1: safe line insertion, dwell limits and removalMedical ExpertPediatrics: Core EPA #3 — Perform neonatal procedures

Your progress

Saved locally on this device.

Practise this topic

Target exams

RACP General PaediatricsRACP DWERACP DCERCPCH Progress+MRCPCH TheoryMRCPCH ClinicalABP General PediatricsACGME PediatricsRCPSC Pediatrics

Red flags

Life stages

fetalneonateinfant

Care settings

delivery-roomnicupicuwarded-acuteretrieval

Clinical exam formats

written-only

Board mappings

The fellowship answer

Umbilical catheterisation uses the two umbilical arteries and the single umbilical vein of the newborn to reach the central arterial and venous circulation without cutting the skin, and it is safe only when the right vessel is cannulated to the right depth and the tip lands in the right place. The umbilical venous catheter runs from the umbilical vein through the ductus venosus into the inferior vena cava, and its tip belongs at the inferior vena cava and right atrium junction at the diaphragm, around the eighth to ninth thoracic vertebra. The umbilical arterial catheter runs from the umbilical artery up the internal iliac and common iliac arteries into the descending aorta, and its tip belongs high, between the sixth and ninth thoracic vertebrae, because the high position sits above the visceral and renal branch vessels and carries fewer ischaemic and thrombotic complications than a low position at the third to fourth lumbar vertebra. The Shukla birth-weight formula estimates the depth: umbilical arterial catheter length equals three times the birth weight in kilograms plus nine centimetres, and umbilical venous catheter length equals half of that value plus one centimetre, with a chest and abdominal radiograph then confirming the tip. The lines come out as soon as they are no longer needed, and no later than five days for an arterial line and fourteen days for a venous line, because dwell time is the single biggest driver of thrombosis, malposition, and line sepsis. [1] [6] [7]

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 · Confirm indication and exclude contraindications

Decide arterial versus venous access, and rule out omphalitis, omphalocele, gastroschisis, and necrotising enterocolitis.

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 · 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 · 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 · 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.

[1] [9]

Paediatrics Fellowship Pro

You have read the opening of this topic. The complete unit — every section and its primary-source references — is part of the Paediatrics Fellowship fellowship atlas.

References12Show ledger

[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

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

high12 referencesUpdated 17 July 202624 min readVerification in progress

Practise this topic

Overview & Definition

From the indication to a confirmed, safe line

1 · Confirm indication and exclude contraindications

Decide arterial versus venous access, and rule out omphalitis, omphalocele, gastroschisis, and necrotising enterocolitis.

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 · 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 · 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 · 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.

[1]

[9]

Paediatrics Fellowship Pro

You have read the opening of this topic. The complete unit — every section and its primary-source references — is part of the Paediatrics Fellowship fellowship atlas.

References12Show ledger

[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