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 Published: 29/11/2011

Umbilical catheters

See also Umbilical Catheter guideline.

UVC in UA, and UAC in UV UAC in the Correct High Position UAC Too High UAC in the Left Subclavian Artery
UAC Not in Far Enough UAC in main pulmonary artery via PDA UAC in Abdomen (somewhere)? UAC in Gluteal Arteries (?)
UVC Too Low  UVC in Liver UVC Looped in Liver UVC in Portal Vein
UVC in Pulmonary Vein UVC in Jugular Vein  UVC in Left Ventricle

UAC in the wrong vessel and UVC in the wrong vessel

  • Be careful to identify the vessels correctly.
  • The image to the right shows the double lumen venous catheter placed in the aorta, and the supposedly arterial catheter inserted into the UVC and - being sited high - in the jugular vein.
  • This tends to make the gas you take off the "arterial" catheter a bit worse than you expected ....
UVCinUACandUACinUVC.jpg (28570 bytes)

UAC in the high position

  • The UAC is at T6, which is satisfactory.  The UVC is at T7.
  • Ideally, both should be above the diaphragm. 
  • The UAC should be between T6 and T9 1.
  • The UVC should be in the IVC as it enters the right atrium.
UAC_correct.jpg (30901 bytes) UAC_correct_lat.jpg (23088 bytes)

UAC in too high

  • This UAC is clearly too high, sitting just below the left subclavian artery.
UAC_ap_subclavian.jpg (47812 bytes) UAC_lat_subclavian.jpg (28719 bytes)

UAC in the left subclavian artery

  • This UAC has been inserted far too deeply in a small baby and has ended up in the left subclavian artery.  Not surprisingly, it was not reading the blood pressure too well, nor sampling well.
  • The UVC probably just enters the right atrium.
LeftSubclavianUAC.jpg (195161 bytes)

UAC not in far enough

  • Two UACs are in place, one in the right iliac artery, the other in the lower aorta at the level of the upper border of L2.
  • Neither position is satisfactory. The left catheter could be in a satisfactory position if withdrawn to L3/4. 1
UAC_ap_RIliac_L2.jpg (36391 bytes) UAC_lat_RIliac_L2.jpg (35784 bytes)

UAC in main pulmonary artery (via PDA)

  • On the AP film, the UAC looks high at T4.
  • Clinically, the baby looked very pink and was saturating at 100%, but the PaO2 on a blood gas through the UAC showed a PaO2 of only 5kPa.
  • On the lateral radiograph, the UAC does not follow the expected course of the aorta and is too anterior.  The UAC follows the PDA and the tip is in the main pulmonary artery.
  • The UVC is also in too far, and interestingly is probably in the left atrium, thereby giving a better indication of PaO2 than the UAC.
UACinMPAviaPDA_AP.jpg (6558 bytes) UACinMPAvia PDA_Lat.jpg (22428 bytes)

UAC in the abdomen (somewhere?)

  • The UVC is in the right atrium, the tip is perhaps a little high, close to the atrial septum.
  • The UAC is looped upon itself and is probably tracking subcutaneously.
UAC_ap_gastric.jpg (52283 bytes) UAC_lat_gastric.jpg (36046 bytes)

UACs in the gluteal arteries

  • Two UACs have been inserted.  Neither is in an appropriate position.  Both enter the umbilical arteries and seem to track posteriorly, possibly into the gluteal arteries.  Contrast has been injected into one of the catheters.
  • The UVC is in a satisfactory position.
UAC_Gluteal_AP.jpg (19622 bytes) UAC_Gluteal_lat.jpg (16189 bytes)

UVC too low

  • The tip of the UVC lies below the diaphragm (too low), though not in the liver.
  • The UAC is positioned too high tending towards the left subclavian artery.
UVC_ap_belowdiaph.jpg (67106 bytes) UVC_lat_belowdiaph.jpg (38308 bytes)

UVC in liver

  • The UVC is coiled and has its tip projected over the right upper quadrant, most likely in the liver.
  • The UAC has its tip at the expected position of the left common iliac artery.
UVC_ap_liver_1.jpg (46577 bytes) UVC_lat_liver_1_1.jpg (59999 bytes)

UVC looped in the liver

  • The UVC on the AP does not appear to be in far enough and is lying in the liver.
  • On the lateral it is clearly looped anteriorly.
  • The UAC is also slightly high at T5.
UVC_Loop_AP.jpg (19623 bytes) UVC_Loop_lat.jpg (13900 bytes)
 
  • In the images to the right, the UVC is also coiled in the liver, but appears to make a correct turn around and exit via the ductus venosus.  The coil is probably within the capacious space where the umbilical vein and left portal vein join.
  • Note is made that the UAC is high at T3.
UVC-CoiledInLiver-AP.jpg (24538 bytes) UVC-CoiledInLiver-Lat.jpg (16496 bytes)

UVC in portal vein

  • The UVC is kinked and lies within the left portal vein in aberrant position.
  • The UAC is in satisfactory position at the level of T8.
UVC_ap_portalvein_1_1.jpg (46619 bytes)

UVC in too far (into pulmonary vein)

  • The tip of UVC has passed across the foramen ovale and likely into the left pulmonary vein.
  • The UAC has its tip at T3/4 interspace (too high).
UVC_ap_pulmvein_1.jpg (31026 bytes)

UVC in too far (into jugular vein)

  • The UVC is too high at the level of the confluence of jugular and subclavian veins.
  • The UAC is in satisfactory position at the level of T6/7 disc space.
UVC_ap_subclavian_1.jpg (43846 bytes)

UVC in too far (into left ventricle)

  • The UVC is in too far, passing through the foramen ovale and into left atrium then left ventricle.
  • The UAC is at T9.
uvc_lvap.jpg (26828 bytes) UVC_LV lateral.jpg (21382 bytes)

References

1

Fletcher MA, MacDonald MG, Avery GB (Eds).  Atlas of procedures in neonatology.  JB Lippincott Co, Phil.

Thanks to Dr Jutta van den Boom for collating some images.

Last updated November 29, 2011