Malpositioned umbilical catheters

Case contributed by Vinay V Belaval
Diagnosis certain


Neonatal intensive care unit admission.

Patient Data

Age: neonate

Intubated child with a malpositioned umbilical arterial catheter (inferiorly looped catheter in right internal iliac artery with its tip facing inferiorly) and malpositioned umbilical venous catheter (possibly in left portal vein with its tip directed posteriorly and to left).

Also noted are pneumomediastinum (Angel wing sign; displaced lobes of thymus glands by air) and left pneumothorax.

A nasogastric tube is noted in situ.

Case Discussion

Neonate in NICU with radiograph of chest and abdomen showing malpositioned umbilical arterial and venous catheters. 

Umbilical arterial catheter (identified by inferior looping of the catheter from the umbilicus to pass through internal iliac artery into aorta) can be placed in high (D6 to D9 vertebral levels) or low (below inferior mesenteric artery) positions in the aorta to avoid mesenteric or renal arterial placement. It is usually placed in a high position. 

Malposition of the arterial catheter into aortic branches can lead to thrombosis or dissection. 

Umbilical venous catheter (identified by more linear course from the umbilical vein into IVC) is ideally placed with its tip in IVC at the level of the diaphragm. The catheter has to pass from umbilical vein into left portal vein, ductus venosus, hepatic vein and then in IVC.

Malposition into hepatic or portal vein can cause thrombosis. Malposition into right atrium can induce arrhythmias. Perforation of portal vein can cause hemorrhage.

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