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Dr.Smah

Umbilical venous Cather in full term infant 2days old

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How are you all I hope fine 

...I would like to read your comments about this x ray according to UVC positioning ?

 

Thanks in advance 

IMG-20190817-WA0005.jpg

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The UVC is clearly malpositioned.  We could have an academic discussion of what vessel you've ended up in, but that thing is never going to get to the IVC/RA junction.

It is also worth noting that the enteric tube appears coiled on itself also needs to be adjusted.

Just curious, but was the indication for line placement?

 

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This is a case of meconium aspiration  on mechanical ventilation Very poor peripheral line ..on dopamine and medazolam infusion .

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Routinely, we would confirm umbilical lines with a cross table lateral view additionally to the AP view.  Although, in the X-ray kindly presented here I do agree with @bimalc the UVC is mal-positioned and no need for a later view.  This UVC could be pulled back to be 2 cm below the level of the base of the umbilical stump = (2 cm + length of the umbilical stump) and be used as a low line = (as a peripheral line) /Or if still a central line is indicated a PICC could be placed. I would revise the need of a central line in this infant. 

In the scenario if this infant was just being resuscitated after delivery and this UVC was just placed in and still the area around the umbilicus is sterile, trying to replace this UVC with a new one, the new UVC will usually follow the track made by the first one. Another way is, if the opening of the umbilical vein could accommodate passing another UVC through without removing the first one, the new UVC could pass in the correct direction. A gentile pressure on the liver downwards and medialy would facilitate passing the UVC in the proper direction. 

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I would have to agree with previous comments regarding abnormal position of this UVC. We also do cross-table lateral views when inserting our umbilical lines but if we have any doubt with that we will get an USS done to confirm position and then withdraw to a low position in the umbilical vein if other access is proving tricky!

 

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