Grand Rounds

Misdirected Umbilical Venous Catheter in a neonate: A case report and anatomical review

Nivetha R, Aiswarya R, Gobinathan S, Kumaravel K S
Department of Pediatrics, Govt. Mohan Kumaramangalam Medical College, Salem, India

Address for Correspondence: K.S.Kumaravel, 191A, Shankar Nagar, Salem, Tamil Nadu, India. PIN: 636007. Email: kumaravelks@rediffmail.com

Keywords: Neonate, Umbilicus, Catheter

Clinical Problem:
A preterm male neonate, born at 34 weeks of gestation, by emergency cesarean section, with a birth weight of 1.8 kg, presented with severe respiratory distress and required central line placement for intensive care management. An umbilical venous catheter (UVC) was planned, and the insertion length was calculated using Shukla’s formula. The UVC was placed under aseptic precautions with an F4 umbilical catheter. Position was clinically confirmed by free flow of blood in either direction. An abdominal X-ray was obtained to confirm the UVC position, which showed the UVC tip in the left portal vein (Fig 1A). The UVC was promptly removed, and vascular access was secured through a peripheral vein.

Fig 1A X -ray of the neonate with an umbilical venous catheter in the left portal vein (arrow) and Fig 1B Anatomy of umbilical and portal venous communication.

Describe the correct course of the umbilical venous catheter?