Almeky Somiah,  Castro Ilse,  Setty Bindu

Final Pr. ID: Poster #: EDU-020

Educational Objectives:
1. Recognize the utility of a UVC catheter in a neonate
2. Understand the anatomy which guides acceptable positioning of a UVC, and identify helpful radiographic and sonographic landmarks
3. Familiarize readers with common complications of UVC catheters through the use of imaging examples, including:
a. Malpositioning/coiling within normal structures
b. Hepatic complications
c. Cardiac complications
4. Learn to recognize the correlation between radiographic and sonographic appearances
5. Understand the utility of ultrasound in monitoring certain complications

Introduction:
Umbilical venous catheterization is a common bedside procedure performed in the Neonatal ICU. As with any procedure, umbilical venous catheterization does not come without risks.

Understanding the basics of fetal circulation is very important in evaluation of neonatal catheters. Because of the distinct anatomy associated with fetal circulation, there are unique complications associated with UVC placement.

The feared complication is placement within the portal venous system, as this may lead to inadvertent infusion of hypertonic fluids such as parenteral nutrition directly into the liver and cause hepatic damage. Radiographs can occasionally reveal findings such as focal lucency corresponding to the area of hepatic necrosis. Ultrasound provides much more detail however and is therefore useful for evaluating and monitoring such complications.

While not seen as frequently, cardiac complications may also result from UVC malpositioning. The catheter can sometimes extend too deep and terminate within the right atrium which can lead to perforation and subsequent pericardial effusion leading to cardiac tamponade. In patients with a patent foramen ovale or atrial septal defect, the catheter tip can even end up within the left atrium and lead to cardiac arrhythmias.

The purpose of this poster is to illustrate the normal anatomy and catheter positioning, as well as to provide a pictorial review of complications that result from UVC malpositioning. Read More

Authors:  Almeky Somiah , Castro Ilse , Setty Bindu

Keywords:  Malposition, NICU, Venous Access