Duration of Umbilical Catheter Use

Recommended Duration for Umbilical Catheters

The American College of Cardiology and other medical societies recommend that umbilical artery catheters (UACs) should optimally not be left in place for more than 5 days, while umbilical venous catheters (UVCs) can be safely used for up to 14 days if managed aseptically, in patients requiring prolonged vascular access 1, 2
Both types of umbilical catheters should be removed as soon as possible when no longer needed, to minimize the risk of complications, according to the Centers for Disease Control and Prevention (CDC) 1, 3

The CDC recommends removing umbilical artery catheters immediately if any signs of catheter-related bloodstream infection (CRBSI), vascular insufficiency in the lower extremities, or thrombosis are present, in order to prevent further complications 1, 4
The CDC also recommends removing umbilical venous catheters immediately if any signs of CRBSI or thrombosis are present, to minimize the risk of infection and other complications 1, 4

An umbilical catheter may be replaced if it is malfunctioning, with no other indication for removal, and the total duration has not exceeded the recommended limits (5 days for UAC, 14 days for UVC), according to the Infectious Diseases Society of America (IDSA) 1, 2

The IDSA recommends cleansing the umbilical insertion site with an antiseptic before catheter insertion, to reduce the risk of infection 1, 5
The CDC advises against using topical antibiotic ointment or creams on umbilical catheter insertion sites, as they may promote fungal infections and antimicrobial resistance 1, 4
The CDC recommends adding low-doses of heparin (0.25–1.0 U/ml) to the fluid infused through umbilical arterial catheters, to prevent thrombosis 1, 5

The CDC recommends monitoring closely for signs of infection, which include fever, chills, and hypotension with no apparent source other than the catheter, and being vigilant for thrombosis formation, particularly in small-for-gestational-age infants 5, 6
The IDSA advises ensuring that catheters are removed under aseptic conditions, to prevent introducing infection, and documenting the date of catheter insertion and establishing a schedule for monitoring and potential removal based on the recommended timeframes 1, 3

The Centers for Disease Control and Prevention (CDC) recommends removing umbilical artery catheters if any signs of catheter-related bloodstream infection (CRBSI) are present, due to the increased risk of infection and other complications 7, 8
The CDC also recommends removing umbilical venous catheters immediately if CRBSI signs develop, to prevent further complications 7, 8
Immediate removal of the umbilical catheter is required if a leak is detected, as it poses significant risks including air embolism, hemorrhage, infection, and catheter fragmentation 7, 9
The American Academy of Pediatrics and other medical societies support the immediate removal of umbilical catheters in the event of a leak, citing the high risk of complications 7, 9

Remove the catheter immediately under aseptic conditions, and do not attempt to replace the catheter through the same site, as recommended by the CDC and other medical societies 7, 8
Establish peripheral IV access or consider PICC line placement if continued central access is needed, according to guidelines from the American College of Cardiology and other organizations 7
A new umbilical catheter may only be placed if the total duration has not exceeded 5 days for umbilical artery catheters or 14 days for umbilical venous catheters, and there are no signs of infection or thrombosis, as recommended by the American Academy of Pediatrics 9

Never attempt to repair or patch a leaking umbilical catheter, as the structural integrity is compromised and replacement is unsafe, according to the CDC and other medical societies 7, 9
Avoid guidewire exchanges for suspected malfunctioning catheters in the setting of possible infection, as recommended by the Infectious Diseases Society of America and other organizations 7, 9
Do not use topical antibiotic ointments at the umbilical site, as these promote fungal infections and antimicrobial resistance, according to the CDC and other medical societies 8