The umbilical venous catheter (UVC) is the only central VAD that is positioned by direct application of the catheter into the vein, without the need for percutaneous puncture. Positioning is obviously only possible at the time of birth, when the umbilical cord vessels are still accessible; the position of the tip - which is traditionally verified with relatively inaccurate systems such as radiology - should be more appropriately verified by echocardiography. In fact, UVC malposition is associated with sometimes very serious complications.
The choice between single and double lumen is mainly related to the clinical conditions of the newborn: in the stable preterm newborn a single lumen UVC is sufficient, while the acutely ill newborn requires a double lumen UVC.
UVC are made of polyurethane: recent evidence (see SHEA guidelines) suggests that UVC made of polyurethane treated with silver ions may be preferable, in order to reduce the risk of infection, especially in newborns with a gestational age less than or equal to 30 weeks .
The caliber of UVC is between 2.5Fr and 8Fr for the single lumens and between 4Fr and 8Fr for the double lumen. The UVC allows high flow, blood sampling, and hemodynamic monitoring. UVC < 4Fr, however, have a relevant risk of occlusion.
UVC is a central catheter potentially burdened by severe complications, both infectious and thrombotic. Within seven days of birth, it should be removed and replaced with an appropriate venous access, which may differ depending on whether the infant is stable or acute-severe.