Chapter 30 ■ Umbilical Vein Catheterization 175

Fig. 30.3. Anteroposterior (A) and lateral (B) radiographs demonstrating the normal

course of an umbilical venous catheter, with an umbilical artery catheter (arrows) in position for comparison. Note how the venous catheter swings immediately superior from the

umbilicus, slightly to the right as it traverses the ductus venosus into the inferior vena cava

(IVC). The distal tip of this line is just superior to the right atrial–IVC junction, and it

might optimally be pulled back slightly into the IVC. Note how the thinner umbilical

artery catheter (arrows) heads inferiorly as it proceeds to the iliac artery and then ascends

posteriorly and to the left until it reaches the level of T7.

A B

imaging techniques may provide a more accurate

assessment of catheter location.

12. Secure catheter as for umbilical artery catheter (see

Chapter 29, E).

There may be more bleeding from the umbilical

vein than from the umbilical artery because the vein is

not a contractile vessel. Local pressure is usually sufficient to stop oozing. For care of an indwelling catheter,

sampling technique, and removal of a catheter, see

Chapter 29.

F. Complications

1. Infections (6,10–15)

2. Thromboembolic (10,13,16,17)

Emboli from a venous catheter may be widely distributed. If the catheter tip lies in the portal system and

the ductus venosus has closed, emboli will lodge in the

liver. If the catheter has passed through ductus venosus,

emboli will go to the lungs or, because of right-to-left

shunting of blood through foramen ovale or ductus

arteriosus in sick newborn infants, emboli may be distributed throughout entire systemic circulation. These

emboli may be infected and, therefore, may cause

widespread abscesses.

3. Catheter malpositioned in heart and great vessels (Figs.

30.5 and 30.6)

a. Pericardial effusion/cardiac tamponade (cardiac perforation) (3,18,19)

b. Cardiac arrhythmias (20)

c. Thrombotic endocarditis (21)

176 Section V ■ Vascular Access

A

B

C