170 Section V ■ Vascular Access

b. Infection (38,64,65)

c. Necrotizing enterocolitis (34,53,54)

d. Intestinal necrosis or perforation (66)

(1) Vascular accident

(2) Infusion of hypertonic solution (67)

e. Transection of omphalocele (Fig. 29.22) (68)

f. Herniation of appendix through umbilical ring (69)

g. Cotton fiber embolus (70)

h. Wharton jelly embolus (71)

i. Hypernatremia

(1) True

(2) Factitious (60)

j. Factitious hyperkalemia (60)

k. Bladder injury (ascites) (31–33)

l. Curving back of the catheter on itself as a result of it

catching in the intima (72)

m.Pseudocoarctation of the aorta (52)

n. Pseudomass in left atrium (73)

o. Displacement by thoracoabdominal abnormality (74)

p. Failure to obtain a lateral x-ray to confirm position

of a percutaneous femoral central line. This failure

led to the failure to recognize that the line is displaced into a spinal vein; it was interpreted by the

radiologist as a correctly placed high umbilical

artery line. (Fig. 29.23)(40)

Fig. 29.21. Anteroposterior roentgenogram demonstrating air

embolism from a UAC in the left subclavian artery (upper arrow)

and the femoral arteries (lower arrows).

Fig. 29.22. Small omphalocele. This gut-containing hernia

was transected during placement of a UAC.

Fig. 29.23. Failure to obtain a lateral radiographic view to confirm the position of this percutaneously placed femoral central

venous line led to failure to recognize that the line is displaced

into a spinal vein. The line was reported by the radiologist as a correctly positioned high umbilical arterial line.

Chapter 29 ■ Umbilical Artery Catheterization 171

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