FIGURE 130.8 A Anatomy for umbilical vessel catheterization B Umbilical artery catheterization C Umbilical vein catheterization Gently grasp the umbilical vein catheter about cm from the tip with either a small clamp or your gloved fingers ( Fig 130.8C ) Introduce the catheter tip into the umbilical vein Apply gentle pressure and advance the catheter through the venous lumen The catheter is inserted until blood flows freely This generally occurs when the catheter tip is just beyond the junction of the umbilicus and the abdominal wall Advance the catheter to the previously estimated depth Tighten the umbilical tape or the purse string suture Tape the catheter in place to further secure it It is important to confirm location of the catheter tip with an x-ray The umbilical vein catheter is usually withdrawn at the end of resuscitation to minimize the danger of infection or portal vein thrombosis; therefore, it is generally not necessary to suture this line in place INTRAOSSEOUS INFUSION Indications Emergency vascular access Favored if intravenous access cannot be rapidly obtained in life-threatening situations Complications Extravasation of fluids or medications into subcutaneous tissue Subcutaneous abscess, osteomyelitis, and bacteremia Physeal injury or fracture Fat embolus