Differential diagnosis of umbilical venous catheter malfunction

• Umbilical venous catheter tip positioned above junction of inferior vena cava and right atrium
• Umbilical venous catheter tip positioned within the liver in the left or right or main portal vein or ductus venous
• Umbilical venous catheter tip positioned beneath the liver in the umbilical vein
• Umbilical venous catheter perforation of vessel during placement
• Umbilical venous catheter tip thrombosis which can extend into any adjacent vein

Approach to the differential diagnosis of umbilical venous catheter malfunction:

• Normal umbilical venous catheter (UVC) course is umbilical vein to left portal vein to ductus venosus to left hepatic vein to inferior vena cava (in and cephalad on an AP image) while coursing through the liver on the lateral image
• The correct position for the umbilical venous catheter tip should be at junction of right atrium / inferior vena cava
• High malposition is an umbilical venous catheter tip positioned too high in the heart usually in the right atrium
• Low malposition is an umbilical venous catheter tip positioned within the liver in a hepatic vein or ductus venosus or portal vein or a catheter tip positioned below the liver in the umbilical vein
• Perforation of vessel during placement should be suspected when the umbilical venous catheter projects over no known vein
• Umbilical venous catheter tip thrombosis which can extend into any adjacent vein