Dear Doctors ...😊 i am back.... missing 99nicu 

Kindly i would like to know your comments on this ..these are 2 xrays of a male full term neonate on mechanical ventilation neonatal spesis ..uvc was inserted in 1 st xray at the level of blue dot ..but after improvement of this severe abdominal distension the level become more deep as in 2nd xray blue dot ...so when inserting uvc how i can overcome the change that abdominal distension can affect the level of fixation 

Thank you in advance😊 

Has the UVC been secured properly and is it still at the appropriate marking

 

Alok

In this case just pull the line 1 cm.

It's worse when you insert the UV line shortly after birth, and when the baby develops distension after a day or two, the tip will be pulled to the level below diaphragm. It happened to me several times. For that reason I try to place the tip rather at T8 then T9. 

If the tip gets pulled to the level below diaphragm on the AP XR,  you may still be able to salvage the line by getting a cross table lateral XR which will show more precisely the position of the tip in relation to the posterior diaphragm, and if you are lucky it may be still positioned above it.  

 

15 hours ago, spartacus007 said:

Has the UVC been secured properly and is it still at the appropriate marking

 

Alok

In fact still fixed from outside at the same level 

14 hours ago, Miro said:

In this case just pull the line 1 cm.

It's worse when you insert the UV line shortly after birth, and when the baby develops distension after a day or two, the tip will be pulled to the level below diaphragm. It happened to me several times. For that reason I try to place the tip rather at T8 then T9. 

If the tip gets pulled to the level below diaphragm on the AP XR,  you may still be able to salvage the line by getting a cross table lateral XR which will show more precisely the position of the tip in relation to the posterior diaphragm, and if you are lucky it may be still positioned above it.  

 

Yes lateral x ray help a lot 👍

Bowel distension May push the diaphragm up but should not effect the vertebral position IVC is retroperitoneal 

This is very important to disseminate. We  experienced 2 cases of cavernomas; my question is would you be for systematic hepatic echography when taking off UVC?