Paediatric

Question 1

How is an emergency Umbilical Vein Catheter inserted?

Answer 1

Indication
- Flat neonate

Contraindications
- Proceduralist inexperience
- >10 days post birth
- Unclear anataomy (Exomphalous, Gastroschisis, cant identify vein)
- Omphalitis, peritonitis
- Abdominal catastrophe/trauma

Procedure
- Clean and prep with chlorhex/iodine swabs, use sterile gloves although emergency placement is aseptic not sterile technique
- Flush line with saline and apply 3-way stop cock
- 5 Fr size in most neonates, 3.5Fr if very premature neonate
- Tie umbilical tape loosely around the base of the umbilicus
- Use a scalpel to cut perpendicularly through the umbilicus at the base of the clamp, leave at least 2cm of cord
- Identify the umbilical vein (larger and thinner wall), look for clot and remove with curved haemostat
- In an emergency only advance until blood is aspirated freely, approximately 5cm
- Aspirate blood then flush line
- Tighten umbilical tape to temporarily secure the line
- Use tape bridge to fully secure the line

Complications
- Infection
- Air embolism
- Thromboembolism
- Lodging in the hepatic vessels causing hepatic damage

Question 2

Explain to a parent how to use an epipen?

Answer 2

• Lie patient flat
• Pull off the blue cover
• Hold leg still, place orange part on outer mid thigh
• Push down hard until click, hold for 3 - 10 seconds then remove pen
• Call 000