Umbilical Cord Cannulation vs IO

[Riblett]

I have looked for information on this topic, and my findings have been minimal. Perhaps I am not looking in the right place...but here is the question.

In neonatal resuscitation, which is the preferred route of drug administration if you are unable to establish peripheral IV? Intra osseous or umbilical vein cannulation? Which provides the most effective access?

Anatomically speaking I would think that, if done properly, the umbilical vein would be the most effective. However, I do not think the difference would be highly significant, and IO would be significantly easier to perform in a neonatal resuscitation. But this is just my opinion.

What does everyone think? Is there any literature supporting one method or the other? Has anyone's experiences favored one over the other?

[ccmedoc]

I think UVC is quicker and more effective, if your protocols allow for it. NRP calls for UVC and does not teach IO as "...there are limited data evaluating the use of intraosseous lines in newborns...". Although they do say it may be acceptable in the out of hospital environment with the previous limitation. This from the Neonatal Resuscitation Textbook, 5th ed, AHA. 2006.

[VentMedic]

The UVC is an excellent choice for a newborn. You can gain practice by hooking up with the local L&D department for the cords to get a better idea of what you will see.

We will do a quick UVC cannulation in the L&D room if needed and replace it later once the baby is stable.