Umbilical Venous Catheter Malfunction / Malposition / Misposition / Misplacement

  • Etiology: placed in premature newborns and term newborns who need central venous access
  • Imaging: 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, catheter tip should be at junction of right atrium / inferior vena cava
  • Complications: catheter tip positioned too high in the heart especially in the right atrium, catheter tip positioned within liver in a hepatic vein or ductus venosus or portal vein, catheter tip positioned below liver in umbilical vein, catheter tip thrombosis which can extend into any adjacent vein, perforation of vessel during catheter placement
  • Treatment: repositioning or removal of malpositioned catheter

Cases of Umbilical Venous Catheter Malfunction / Malposition / Misposition / Misplacement

AXR of umbilical venous catheter in appropriate position
AXR AP and cross-table lateral shows normal course of the umbilical venous catheter from umbilical vein to left portal vein to ductus venosus to left hepatic vein to inferior vena cava (in and cephalad on the AP view) while coursing through the liver on the lateral view with the catheter tip positioned at the junction of the inferior vena cava and right atrium. The umbilical arterial catheter has a normal course from umbilical artery to internal iliac artery to common illiac artery to aorta (in and caudad and then cephalad on the AP view) while coursing anterior to the spine on the lateral view with the catheter tip at T5.
AXR of low malposition of an umbilical arterial catheter
AXR supine shows an umbilical arterial catheter that loops back upon itself in the aorta and whose tip projects in the right iliac artery at S3. The umbilical venous catheter tip projects at the junction of the inferior vena cava and the right atrium.
CXR of umbilical venous catheter in a pulmonary vein
CXR AP shows the umbilical venous catheter coursing into the right atrium, through a patent foramen ovale, into the left atrium and then into a left pulmonary vein. The umbilical arterial catheter tip is at T4. There is faint ground glass opacity in the lungs.
CXR of umbilical venous catheter in the left pulmonary vein
CXR AP shows one umbilical venous catheter coursing into the right atrium, through a patent foramen ovale, into the left atrium and then into a left pulmonary vein. Another umbilical venous catheter has its tip projecting intrahepatically within the main portal vein. The umbilical arterial catheter tip is at T8.
AXR of umbilical venous catheter in the right subclavian vein
CXR AP shows the tip of one umbilical venous catheter to be in the superior vena cava with the tip of the other umbilical venous catheter curled within the right atrium. The tip of the endotracheal tube is in the right mainstem bronchus. The lungs have ground-glass opacity.
CXR of umbilical venous catheter in right atrium and superior vena cava
CXR AP shows the tip of one umbilical venous catheter to be in the superior vena cava with the tip of the other umbilical venous catheter curled within the right atrium. The tip of the endotracheal tube is in the right mainstem bronchus. The lungs have ground-glass opacity.
CXR of umbilical arterial catheter in left subclavian artery
CXR AP shows the tip of the umbilical arterial catheter to be in the left subclavian artery. The tip of the umbilical venous catheter is deep within the right atrium. The lungs show minimal ground-glass opacity.
CXR of nasogastric tube in mid-esophagus
CXR AP shows the tip of the nasogastric tube in the mid esophagus. The tip of the umbilical venous catheter is too high in the right atrium and the tip of the umbilical arterial catheter is too high in the aortic arch.
AXR of normal position of an umbilical arterial catheter
AXR AP and cross-table lateral shows normal course of the umbilical arterial catheter from umbilical artery to internal iliac artery to common illiac artery to aorta (in and caudad and then cephalad on the AP view) while coursing anterior to the spine on the lateral view with the catheter tip appropriately positioned at T7. The umbilical venous catheter has a normal course from umbilical vein to left portal vein to ductus venosus to left hepatic vein to inferior vena cava (in and cephalad on the AP view) while coursing through the liver on the lateral view with the catheter tip positioned in the right atrium
AXR of umbilical arterial catheter perforation
Supine AXR shows the tip of the umbilical arterial catheter to project in the left abdomen over no known arterial vessel. The tip of the umbilical venous catheter projects within the liver.
AXR of umbilical venous catheter in the right portal vein
Initial AXR AP (left) shows the umbilical venous catheter tip in the main portal vein and the tip of the umbilical arterial catheter at T8. Later AXR AP (right) shows the umbilical venous catheter tip in the right portal vein.
CXR of umbilical arterial catheter malposition
CXR AP shows the tip of the umbilical arterial catheter to be at T3 near the aortic arch. The tip of the umbilical venous catheter is in the right portal vein. The lungs show diffuse ground-glass opacity.
AXR of umbilical venous catheters in the left portal vein and right portal vein
AXR AP shows the tip of the first umbilical venous catheter curled back upon itself in the right portal vein with the tip of the second umbilical venous catheter in the left portal vein. The tip of the umbilical arterial catheter is at T7.
AXR of portal venous gas from an umbilical venous catheter in the right portal vein
CXR AP shows the tip of the umbilical venous catheter to be in the right portal vein. There is air in the portal venous system. The umbilical arterial catheter projects at T9. There is mild ground-glass opacity in the lungs.
AXR of umbilical venous catheter in the right portal vein
AXR AP (above) and cross-table lateral AXR (below) shows the tip of the umbilical venous catheter to be positioned deep within the right portal vein. The tip of the umbilical arterial catheter is at T4.
AXR of umbilical venous catheter in right portal vein
CXR AP shows the tip of the umbilical venous catheter within the right portal vein. The tip of the umbilical arterial catheter is at T5. There is ground-glass opacity in the lungs.
AXR of umbilical venous catheter in right portal vein
AXR AP shows the tip of the umbilical venous catheter within the right portal vein. The tip of the umbilical arterial catheter is at T8.
AXR of umbilical venous catheter in the left portal vein
AXR AP shows the tip of the umbilical venous catheter projecting over the left portal vein. The tip of the umbilical arterial catheter projects at T9.
AXR of umbilical venous catheter in the left portal vein
CXR AP shows the tip of the umbilical venous catheter projecting over the left portal vein. The tip of the umbilical arterial catheter projects at T6. There is hazy ground glass opacity in the lungs.
AXR of umbilical venous catheter perforation out of vein
Supine AXR (upper left) shows the umbilical venous catheter tip coursing to the left of midline. Cross-table lateral AXR (upper right) shows the umbilical venous catheter tip projecting over the anterior abdomen with air bubbles along the catheter tract. CXR taken after placement of a second umbilical venous catheter (below) shows the new umbilical venous catheter tip in the right or left atrium and the first umbilical venous catheter tip projecting over the left upper quadrant over no known vein with air bubbles along its tract. US subsequently showed the tip of the first umbilical venous catheter was in the subcutaneous tissues of the anterior abdominal wall.
AXR and CT of extravasation of TPN into the liver due to umbilical venous catheter perforation out of the vein
AXR AP shows the tip of the umbilical venous catheter to project over the left portal vein. Axial CT with contrast of the abdomen shows multiple low density lesions which appear to be joined together in the left lobe of the liver.