Umbilical cannulation

[Sizz]

Has anyone preformed or is very familiar with pre-hospital umbilical cannulation? It's in my scope of practice and while I was attending medic school I'm pretty sure I was taught to access the vein directly in an absolute emergency if needed in per say a preterm baby where the IO might not be viable with an over the needle cath w/out the needle of course with a syringe for ALS drug administration.

I'm attending a PEPP course in a neighboring state were it appears after I looked this is not in the scope for medics in this state...and when the topic came up I explained how I was taught and the locals thought this was crazy and that I needed a "special kit" for this which I'm unfamiliar with as well acted like I was crazy for thinking I could attempt this pre-hospital in my scope which it is.

I ended up checking my state and level of certification's scope of practice online at the states ems site...and it's listed.

What's your thoughts?

 

[Smash]

Umbilical cannulation can be achieved with 'regular' equipment found on ambulances. In hospital it is generally done with a soft catheter that is threaded into the umbilical vein and is then tied off, rather than actually cannulating the vein.

A catheter without the trocar can be used as you mention or you could clamp the distal end and actually cannulate the vein.

Umbilical catheterization is definitely associated with some pretty significant risks and it's not something I would attempt unless I had no choice.

 

[WTEngel]

We use a UVC or UAC kit to gain access to the vessels of the umbilicus. We throw in a stitch to secure it to the patient or place an opsite over it.

Gaining access in the field with standard equipment is not ideal. To be honest with you, for the prehospital provider who is not familiar with NRP guidelines and not experienced at running premature infant and neonatal codes, good strong BLS is probably the best thing you can do for the baby. The risk of horrible blood stream infection, false tracking into the abdomen with an IV catheter, and just plain wasting time gaining access for a patient who you most likely do not know what medications in which doses you are about to give seems to outweigh the benefit.

Take it from a guy who has done a few UVCs and UACs...it sounds all well and good in class, but in real life, if you have never actually done it, and you are in the heat of the moment and under a lot of stress, it is not the time to be experimenting. You will most likely make matters worse.

That is just my $.02 though...

 

[8jimi8]

Try the search function this has been covered. But these two guys said all ghat needs to be said.

 

[usalsfyre]

Remember that an umbilical catheter is central access. Would you be comfortable placing an IJ or subclavian in the field?

 

[abckidsmom]

Remember that an umbilical catheter is central access. Would you be comfortable placing an IJ or subclavian in the field?

With whatever random thing you had on hand?

In an already critical patient?

In a world that contains the EZIO?

 

[8jimi8]

With whatever random thing you had on hand?

In an already critical patient?

In a world that contains the EZIO?

Ezio is approved for neonates?

 

[usalsfyre]

Ezio is approved for neonates?

It's approved down to 3 kgs. Premies you'll have to find another option though (although if you deliver a 30 weeker in the field you've probably got bigger concerns).

 

[Sizz]

With whatever random thing you had on hand?

In an already critical patient?

In a world that contains the EZIO?

As for the IJ or subclavian no I would not be comfortable as for the more accessible umbilical cord from newly delivered 6 pound or less newborn or preterm neonate who's severely depressed and needs aggressive resuscitation I would consider it my last option. I'm not guessing I'm going to find a peripheral vein and the IO not being viable the newborn being very small would you think dumping drugs down the ET would better suit the child than using an umbilical catheter and unclamping and administering meds via the umbilical vein? Both come with risks but at this point where the child is needing aggressive treatment do the risks out weigh the outcome?

As WTEngel put it well good BLS and quality CPR is what I'll focus on until I've resuscitated a few newborns as well as become more familiar with the NRP guidelines.

Either way I appreciate the feedback.

 

[usalsfyre]

Don't forget the scalp as a viable site.

The risk begin to outweigh the benefits when you realize that taking away from basic resuscitation to do risky, unfamiliar procedures is a good way to hasten death. Just because an umbilical vein is more accessible doesn't mean it's any less risky.

 

[Sharktooth]

Try the search function this has been covered. But these two guys said all ghat needs to be said.

pipe down.....its a freakin discussion forum . If everyone used the search feature we there probably wouldnt be many posts here now would there....the same question at a different time might introduce new information or a fresh perspective .