Investigation of umbilical venous vessels anatomy and diameters as a guideline for catheter placement in newborns

Abstract

Umbilical cord catheters (UCC) are important for the primary care of critically ill newborns. To analyze anatomical variations of the umbilical vein (UV) and its further course, we performed abdominal spiral-CT examinations on stillborns. The aim of the study was to explore the high incidence of mal-positioned UCCs and to improve their positioning. Eighteen stillborns were investigated (29.2 weeks ± 6.7 weeks (IQR)). CTs were performed using either air or contrast medium injection into the UV. We measured the diameter at the narrowest points of (i) the umbilical vein, (ii) the segmental portal vein, (iii) the left portal vein, (iv) the umbilical recess, and (v) the ductus venosus. The branching angles between (a) the umbilical vein and intrahepatic veins and (b) the ductus venosus and umbilical recess were measured. The diameter of the UV increases from 3.4 to 11 mm (median [IQR]:4.6 mm [4.2-6.9]: r = 0.64). The left portal vein has a larger diameter (3.6 mm [2.6-4.55]; r = 0.43) than the left segmental portal vein (2.3 mm [1.8-2.75]; r = 0.23). The diameter of the ductus venosus (2.5 mm [1.6-3.4]; r = 0.59) is half that of the umbilical recess (5.1 mm [3.3-6.2]; r = 0.43). The most obtuse angle is formed by the junction between the umbilical recess and ductus venosus (151° [133-159]; r = 0.001). The branch angle from the outgoing UV into the left portal vein is more obtuse (128° [123-144]; r = 0.0001) than that of the segmental portal vein (115° [105-119]; r = 0.0001). To avoid mal-positioning, our data suggest the use of a soft catheter. The UV and its extensions are wide enough to admit a 4 Fr. catheter without complete obstruction. Clin. Anat. 31:269-274, 2018. © 2017 Wiley Periodicals, Inc.

Point-of-care ultrasound for monitoring catheter tip location during umbilical vein catheterization in neonates: a prospective study

“…UVC catheter tip displacement can be affected by factors including pulmonary disease, diaphragm movement, mechanical ventilation pattern ( 19 , 20 ), abdominal circumference change ( 21 ), and umbilical stump contracture ( 2 ). The main diseases among our sample were NRDS in 41 patients (60.3%, 41/68) and mechanical ventilation in 53 patients (79.3%, 53/68).…”

“…Umbilical vein catheterization (UVC) is an important infusion channel in neonatal intensive care ( 1 ). Anatomical routes include the umbilical vein, extraperitoneal segment, intrahepatic segment, umbilical crypt, venous catheter, and inferior vena cava (IVC) ( 2 ). The ideal UVC tip location is outside the heart at the junction of the IVC and right atrium (RA) ( 3 ).…”

(Gefäß-)Anatomie im Neugeborenen-, Säuglings- und Kleinkindesalter

“…Diese Entwicklungsabhängigkeit führt dazu, dass einerseits die Pulmonalarterien mit dem Bronchialgerüst, andererseits die Pulmonalvenen mit den Bindegewebssepten wachsen und anatomisch verbunden sind. laris [12]. Von dort verläuft sie medial des Processus styloideus hinter dem M. sternocleidomastoideus nach medial-kaudal zum Venenwinkel.…”

“…Die Nabelvene ist breit genug, um einen 4-French-Katheter ohne vollständige Okklusion zuzulassen [12]. nierte Katheter können jedoch steril zurückgezogen werden.…”

Italian inter-society expert panel position on radiological exposure in Neonatal Intensive Care Units

“…Secondary indications are the infusion of solutions, drugs and the need of blood tests. Possible side effects to the positioning of an umbilical (UVC) venous catheter are omphalitis, omphalocele, necrotizing enterocolitis (NEC), peritonitis or damage from the infusion extravasation [ 33 ]. Umbilical Artery Catheterization (UAC) Low position (L3-L5, under inferior mesenteric artery), high position (T6-T9, thoracic aorta, over the celiac-mesenteric-renal arteries) [ 34 ].…”