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Am J Perinatol
DOI: 10.1055/a-2662-8526
Original Article

Line Insertion through a Long Umbilical Stump: A Concept Generating Laboratory Study

Itamar Nitzan    *
1   Department of Neonatology, Shaare Zedek Medical Center, Jerusalem, Israel
2   Department of Pediatrics, The Hebrew University of Jerusalem, Jerusalem, Israel
,
Yshia Langer   *
2   Department of Pediatrics, The Hebrew University of Jerusalem, Jerusalem, Israel
3   Department of Pediatric Critical Care, Hadassah-Hebrew University Medical Center, Jerusalem, Israel
,
Yair Kasirer 
1   Department of Neonatology, Shaare Zedek Medical Center, Jerusalem, Israel
2   Department of Pediatrics, The Hebrew University of Jerusalem, Jerusalem, Israel
,
Lea L. Nasich 
1   Department of Neonatology, Shaare Zedek Medical Center, Jerusalem, Israel
,
Robert Koppel
4   Department of Pediatrics, Donald and Barbara Zucker School of Medicine at Hofstra/Northwell, Hempstead, New York
5   Neonatal-Perinatal Medicine, Cohen Children's Medical Center, New Hyde Park, New York
,
Francis B. Mimouni
6   Leumit Health Services and the Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
,
Anup C. Katheria
7   Neonatal Research Institute, Sharp Mary Birch Hospital for Women and Newborns, San Diego, California
› Author Affiliations
Funding None.
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Abstract

Objective

Umbilical line insertion involves discomfort for preterm infants. We hypothesized that a 10- to 20-cm umbilical cord segment can be catheterized with an appropriate guide wire. This may facilitate line establishment with minimal baby discomfort.

Study Design

A laboratory proof-of-concept study, performed on umbilical cord segments removed from babies after delivery. In phase 1, we used a variety of techniques to determine an ideal method for long-segment umbilical vein catheterization. In phase 2, we documented the rate of successful catheter advancement using this method.

Results

We successfully advanced the catheter from the insertion point to the proximal end of the cord, an average distance of 15.7 ± 3.5 cm, in 7 out of 10 cords.

Conclusion

It is possible to advance a catheter within the umbilical vein through a long umbilical cord segment. Clinical studies are required to evaluate whether this method may facilitate minimal handling insertion of umbilical catheters.

Key Points

  • This is an umbilical vein cannulation proof-of-concept laboratory study.

  • A line can be advanced 10 to 20 cm in an umbilical cord.

  • The proposed technique may support a minimal handling approach.

  • Further clinical studies are required.

Keywords

umbilical line - umbilical cord - newborns - preterm infant - minimal handling - Seldinger technique

* These authors contributed equally to the study.




Publication History

Received: 28 January 2025

Accepted: 22 July 2025

Article published online:
04 August 2025

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