NRP Umbilical Catheter Placement and Vascular Access

Question 1

How do you distinguish the umbilical vein from the umbilical arteries when preparing to insert an umbilical venous catheter (UVC)?

Accepted Answer

The vein is a single, larger, thin-walled vessel; the two arteries are smaller with thicker, more muscular walls

Answer

The vein is smaller and has a thicker wall; the arteries are larger and thin-walled

Answer

The vein is located at the 3 and 9 o'clock positions; the arteries are at 12 o'clock

Answer

The vein has blue dye injected during delivery; the arteries do not

Question 2

To what depth should an umbilical venous catheter be inserted for emergency use during neonatal resuscitation?

Accepted Answer

Until blood can be freely aspirated — approximately 2–4 cm

Answer

To the full manufacturer-specified length

Answer

Until the tip reaches the inferior vena cava–right atrium junction (calculated depth)

Answer

5 cm past the umbilical ring regardless of infant size

Question 3

What is the primary advantage of intraosseous (IO) access over umbilical venous catheter access during neonatal resuscitation?

Accepted Answer

IO access can be established more quickly when UVC placement is difficult or unsuccessful

Answer

IO access delivers medications more rapidly than UVC

Answer

IO access is safer in preterm infants due to their thin umbilical tissue

Answer

IO access avoids the risk of air embolism associated with UVC

Question 4

What complication is most specifically associated with deep or malpositioned UVC placement into the portal venous system?

Accepted Answer

Portal vein thrombosis or portal hypertension from infusion of hypertonic solutions

Answer

Cardiac arrhythmia from catheter tip stimulating the right atrium

Answer

Pneumothorax from accidental puncture of the lung apex

Answer

Pulmonary embolism from air introduced into the catheter

Question 5

Which of the following is a contraindication to umbilical venous catheter insertion?

Accepted Answer

Omphalocele, gastroschisis, or omphalitis

Answer

Birth weight less than 1 kg

Answer

Gestational age less than 28 weeks

Answer

Need for simultaneous chest compressions

Question 6

After successfully inserting a UVC and confirming blood can be aspirated, what is the next critical step before administering medications?

Accepted Answer

Flush the catheter with normal saline to confirm patency and ensure no air is present in the line

Answer

Obtain a chest X-ray to confirm tip position

Answer

Flush the catheter with heparinized saline and secure it with sutures

Answer

Measure the length of catheter inserted and document it