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Umbilical Catheter Positions and Complications
A. Carlson Merrow, Jr., MD, FAAP
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KEY FACTS

  • Terminology

    • Imaging

      • Diagnostic Checklist

        TERMINOLOGY

        • Definitions

          • Umbilical venous catheter (UVC)
            • Normal course: Umbilical vein → umbilical recess → left portal vein → ductus venosus → middle or left hepatic vein → inferior vena cava (IVC) → right atrium (RA)
            • Indications: Central venous access in ill/premature neonate for fluids/medications, total parenteral nutrition (TPN), exchange transfusion, venous pressure monitoring
            • UVC can be maintained 7-14 days
          • Umbilical arterial catheter (UAC)
            • Normal course: Umbilical artery → internal iliac artery → common iliac artery → aorta
            • Indications: Frequent blood sampling, monitoring of arterial pressures, angiography, exchange transfusion
            • UAC can be maintained 7-10 days

        IMAGING

        • Radiographic Findings

          • Ultrasonographic Findings

            • Imaging Recommendations

              PATHOLOGY

              • General Features

                CLINICAL ISSUES

                • Presentation

                  • Treatment

                    DIAGNOSTIC CHECKLIST

                    • Consider

                      • Reporting Tips

                        Selected References

                        1. Ullman AJ et al: Complications of Central Venous Access Devices: A Systematic Review. Pediatrics. 136(5):e1331-44, 2015
                        2. Arnts IJ et al: Comparison of complication rates between umbilical and peripherally inserted central venous catheters in newborns. J Obstet Gynecol Neonatal Nurs. 43(2):205-15, 2014
                        3. Fuchs EM et al: Umbilical venous catheter-induced hepatic hematoma in neonates. J Neonatal Perinatal Med. 7(2):137-42, 2014
                        4. Grizelj R et al: Severe liver injury while using umbilical venous catheter: case series and literature review. Am J Perinatol. 31(11):965-74, 2014
                        5. Hagerott HE et al: Clinical-radiologic features and treatment of hepatic lesions caused by inadvertent infusion of parenteral nutrition in liver parenchyma due to malposition of umbilical vein catheters. Pediatr Radiol. 44(7):810-5, 2014
                        6. Harabor A et al: Rates of intracardiac umbilical venous catheter placement in neonates. J Ultrasound Med. 33(9):1557-61, 2014
                        7. Hoellering AB et al: Determination of umbilical venous catheter tip position with radiograph. Pediatr Crit Care Med. 15(1):56-61, 2014
                        8. Marshall M: Radiographic assessment of umbilical venous and arterial catheter tip location. Neonatal Netw. 33(4):208-16, 2014
                        9. Park CK et al: Neonatal central venous catheter thrombosis: diagnosis, management and outcome. Blood Coagul Fibrinolysis. 25(2):97-106, 2014
                        10. Oestreich AE: Umbilical vein catheterization--appropriate and inappropriate placement. Pediatr Radiol. 40(12):1941-9, 2010
                        11. Blondiaux E et al: Calcified aneurysm of the abdominal aorta 12 years after umbilical artery catheterization. Pediatr Radiol. 38(2):233-6, 2008
                        12. Wyers MR et al: Umbilical artery catheter use complicated by pseudoaneurysm of the aorta. Pediatr Radiol. 32(3):199-201, 2002
                        13. Hogan MJ: Neonatal vascular catheters and their complications. Radiol Clin North Am. 37(6):1109-25, 1999
                        Related Anatomy
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                        Related Differential Diagnoses
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                        References
                        Tables

                        Tables

                        KEY FACTS

                        • Terminology

                          • Imaging

                            • Diagnostic Checklist

                              TERMINOLOGY

                              • Definitions

                                • Umbilical venous catheter (UVC)
                                  • Normal course: Umbilical vein → umbilical recess → left portal vein → ductus venosus → middle or left hepatic vein → inferior vena cava (IVC) → right atrium (RA)
                                  • Indications: Central venous access in ill/premature neonate for fluids/medications, total parenteral nutrition (TPN), exchange transfusion, venous pressure monitoring
                                  • UVC can be maintained 7-14 days
                                • Umbilical arterial catheter (UAC)
                                  • Normal course: Umbilical artery → internal iliac artery → common iliac artery → aorta
                                  • Indications: Frequent blood sampling, monitoring of arterial pressures, angiography, exchange transfusion
                                  • UAC can be maintained 7-10 days

                              IMAGING

                              • Radiographic Findings

                                • Ultrasonographic Findings

                                  • Imaging Recommendations

                                    PATHOLOGY

                                    • General Features

                                      CLINICAL ISSUES

                                      • Presentation

                                        • Treatment

                                          DIAGNOSTIC CHECKLIST

                                          • Consider

                                            • Reporting Tips

                                              Selected References

                                              1. Ullman AJ et al: Complications of Central Venous Access Devices: A Systematic Review. Pediatrics. 136(5):e1331-44, 2015
                                              2. Arnts IJ et al: Comparison of complication rates between umbilical and peripherally inserted central venous catheters in newborns. J Obstet Gynecol Neonatal Nurs. 43(2):205-15, 2014
                                              3. Fuchs EM et al: Umbilical venous catheter-induced hepatic hematoma in neonates. J Neonatal Perinatal Med. 7(2):137-42, 2014
                                              4. Grizelj R et al: Severe liver injury while using umbilical venous catheter: case series and literature review. Am J Perinatol. 31(11):965-74, 2014
                                              5. Hagerott HE et al: Clinical-radiologic features and treatment of hepatic lesions caused by inadvertent infusion of parenteral nutrition in liver parenchyma due to malposition of umbilical vein catheters. Pediatr Radiol. 44(7):810-5, 2014
                                              6. Harabor A et al: Rates of intracardiac umbilical venous catheter placement in neonates. J Ultrasound Med. 33(9):1557-61, 2014
                                              7. Hoellering AB et al: Determination of umbilical venous catheter tip position with radiograph. Pediatr Crit Care Med. 15(1):56-61, 2014
                                              8. Marshall M: Radiographic assessment of umbilical venous and arterial catheter tip location. Neonatal Netw. 33(4):208-16, 2014
                                              9. Park CK et al: Neonatal central venous catheter thrombosis: diagnosis, management and outcome. Blood Coagul Fibrinolysis. 25(2):97-106, 2014
                                              10. Oestreich AE: Umbilical vein catheterization--appropriate and inappropriate placement. Pediatr Radiol. 40(12):1941-9, 2010
                                              11. Blondiaux E et al: Calcified aneurysm of the abdominal aorta 12 years after umbilical artery catheterization. Pediatr Radiol. 38(2):233-6, 2008
                                              12. Wyers MR et al: Umbilical artery catheter use complicated by pseudoaneurysm of the aorta. Pediatr Radiol. 32(3):199-201, 2002
                                              13. Hogan MJ: Neonatal vascular catheters and their complications. Radiol Clin North Am. 37(6):1109-25, 1999