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Umbilical Vein Puncture – Definition & Use

Umbilical vein puncture is a medical procedure in which a needle or catheter is inserted into the umbilical vein to draw blood or administer medications.

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Umbilical vein puncture is a medical procedure in which a needle or catheter is inserted into the umbilical vein to draw blood or administer medications.

What Is Umbilical Vein Puncture?

Umbilical vein puncture is an invasive medical procedure in which a thin needle or catheter is introduced into the umbilical vein (vena umbilicalis). It is used in both neonatal medicine and prenatal diagnostics. In the fetus, the umbilical vein carries oxygen-rich blood from the placenta to the liver and heart. After birth, it closes within a few days and becomes the ligamentum teres hepatis.

Indications and Applications

In Newborns

In newborns, especially premature or critically ill infants, umbilical vein puncture is frequently used to establish rapid venous access. The resulting umbilical venous catheter (UVC) allows clinicians to:

Administer infusions and medications
Provide blood products and transfusions
Monitor central venous pressure
Collect blood samples for laboratory analysis
Perform exchange transfusions in cases of severe neonatal jaundice (hyperbilirubinemia) or Rh incompatibility

In Prenatal Diagnostics

In the unborn child, umbilical vein puncture can be performed as part of fetal blood sampling (cordocentesis). Under continuous ultrasound guidance, a needle is inserted through the mother's abdominal wall into the fetal umbilical vein. Indications include:

Diagnosis of chromosomal abnormalities or genetic disorders
Assessment of the fetal blood count (e.g., suspected fetal anemia)
Intrauterine blood transfusion in severe Rh conflict
Treatment of fetal cardiac arrhythmias
Measurement of infection markers (e.g., suspected toxoplasmosis or CMV)

How the Procedure Is Performed

Umbilical Venous Catheter in Newborns

In newborns, the umbilical vein is accessed shortly after birth while the umbilical stump is still soft and patent -- usually within the first 24 to 72 hours of life. Under sterile conditions, a thin catheter is introduced into the umbilical vein and advanced to the inferior vena cava or the right atrium of the heart. Correct catheter placement is confirmed by X-ray or echocardiography.

Cordocentesis in the Fetus

Cordocentesis is typically performed between 18 and 36 weeks of gestation. Under continuous ultrasound guidance, a fine needle is passed through the mother's abdominal wall into the umbilical cord, where blood is withdrawn from the umbilical vein or therapy is administered. Local anesthesia is applied to the abdominal wall before the procedure.

Risks and Complications

As with any invasive procedure, umbilical vein puncture carries certain risks:

Infection (catheter-related sepsis, omphalitis)
Thrombosis or embolism associated with the catheter
Air embolism if the catheter is handled improperly
Cardiac arrhythmias if the catheter is positioned too deeply
Liver injury from malpositioned catheter tip
In cordocentesis: fetal bradycardia, bleeding at the puncture site, preterm labor, or -- rarely -- pregnancy loss

Contraindications

Absolute contraindications for umbilical venous catheterization in newborns include omphalitis (navel infection), omphalocele, and gastroschisis. For cordocentesis, placenta previa or poor ultrasound visualization of the umbilical cord insertion are considered relative contraindications.

Follow-Up and Monitoring

After umbilical venous catheter placement, the insertion site is closely monitored for signs of infection or circulatory compromise. The catheter should be removed as early as clinically possible -- generally within 14 days at most -- to minimize infection risk. Following cordocentesis, fetal heart rate is monitored using cardiotocography (CTG).

References

Gomella, T.L. et al.: Neonatology: Management, Procedures, On-Call Problems, Diseases, and Drugs. 8th edition. McGraw-Hill Education, New York, 2020.
Nicolaides, K.H.: The 11-13 weeks scan and cordocentesis. Fetal Medicine Foundation, London, 2004.
World Health Organization (WHO): Recommendations on Newborn Health. WHO Press, Geneva, 2017. Available at: https://www.who.int

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