Survey of Medication Administration Through Umbilical Arterial and Venous Catheters

Lisa Smith, Robin Dills

Disclosures

Am J Health Syst Pharm. 2003;60(15) 

In This Article

Introduction

The use of umbilical arterial catheters (UACs) has been a standard of practice for 30 years in neonatal intensive care units (NICUs).[1] They have proven useful for continuous blood pressure monitoring, blood gas sampling, exchange transfusions, cardiac catheterizations, and infusion of fluids and nutrients. However, administering drugs through a UAC is controversial because it is associated with complications, including thrombosis, embolism, vasospasm, blood vessel perforation, hemorrhage, infection, and hypertension.[2,3]

The potential for complications has resulted in institutional policies restricting UAC use. Some NICUs allow UACs to be used only for blood gas sampling, while others use them to administer medications, fluids, nutrition, and blood products. There has been limited research investigating the association between medication administration through a UAC and the frequency of complications.

In addition, data on specific medications to administer through a UAC are scarce. Adverse reactions have been reported when administering vasoactive agents (e.g., dopamine, epinephrine),[4,5,6] hypertonic and hypotonic solutions,[7] and hyperosmolar solutions[8] through a UAC. It has been theorized that a rapid bolus dose of fluid through a catheter could create a "fluid jet" with enough force to traumatize a blood vessel wall.[9]

A randomized prospective study investigated the effect of the area of UAC placement on complication rates in neonates who received ampicillin and gentamicin through a UAC.[10] Catheters placed in a low position (between the 3rd and 4th lumbar vertebrae) had a 78% incidence of complications, whereas catheters placed in a high position (between the 5th and 10th thoracic vertebrae) had a 39% incidence of complications. Independent of catheter position, the administration of ampicillin and gentamicin resulted in an increased rate of blanching, catheter clot, and pseudomembranous enterocolitis.

The frequency of complications when total parenteral nutrition (TPN) solutions were infused through a UAC versus a central venous catheter was compared.[11] There were no significant differences in rates of complications, such as sepsis, aortic thrombus, hypertension, and tricuspid valve vegetation. The authors concluded that the umbilical artery is a reasonable route for infusing TPN solutions.

In 1990, 100 institutions were surveyed about the use of medications administered through UACs.[12] Sixty-three responding NICUs indicated those medications that were considered safe and unsafe for UAC administration. Several medications considered safe by some institutions were deemed unsafe by others. None of the respondents provided specific criteria for determining whether a medication was safe for UAC administration.

The purpose of this survey was to collect data regarding the policies and practices of NICUs in the United States concerning medication administration through UACs and umbilical venous catheters (UVCs).

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