178 Section V ■ Vascular Access

A B

C D

Fig. 30.6. Spectrum of malpositions of umbilical venous catheters (UVCs) (A–C). A: UVC in right

portal vein with secondary air embolization into portal venous system. B: UVC in splenic vein. UAC catheter in good position with its tip at T7. C: UVC extending through heart into the superior vena cava.

D, E: Spectrum of malpositions of UVCs. The anteroposterior film (D) shows an indeterminate position

of the UVC. The right atrium, the right ventricle, and the left atrium are all possibilities.

Chapter 30 ■ Umbilical Vein Catheterization 179

I

H

G

F

E

Fig. 30.6. (continued) The lateral film (E) shows its posterior position, confirming its presence in the

left atrium. The lateral film is particularly important in making this distinction. Measurement of the PO2

in blood from the catheter will be diagnostic of misplacement, unless the infant has severe persistent pulmonary hypertension or other cause of severe intracardiac shunting. F–I: Spectrum of malpositions of

UVCs. Series of radiographs demonstrating various malpositions of a venous catheter: right pulmonary

artery (F), left main pulmonary artery (G), main pulmonary artery (H), and right ventricle (I).

180 Section V ■ Vascular Access

References

1. Nickerson BG, Sahn DJ, Goldberg SJ, et al. Hazards of

inadvertent venous catheterization in a patient with anomalous

pulmonary venous drainage: a case report. Pediatrics. 1979;

63:929.