If the Umbilical Catheter Vein goes to portal sistem.... and the radiographics show your catheter in portal vein, in a preterm 25 sem with 8 h age with RDS and mecanical ventilation.... What do you  usually do?  

Thanks

 

We would do a PICC line to replace the UVC!

Hi,

I would also switch to a PICC line.

Otherwise, I can warmly recommend using ultrasound when placing the UVC!

This article is a wonderful overview of how to use it while placing the UVC. Check out the videos!

Kozyak BW, Fraga MV, Juliano CE, Bhombal S, Munson DA, Brandsma E, et al. Real-Time Ultrasound Guidance for Umbilical Venous Cannulation in Neonates With Congenital Heart Disease. Pediatr Crit Care Med. 2022 May 1;23(5):e257–66.

https://pubmed.ncbi.nlm.nih.gov/35250003/

With kind regards from Mainz

Dirk

I have observed that when the tip of the umbilical venous catheter is right at the bifurcation of the portal system: the rate of perfusion, the volume infused, and when parenteral nutrition is started, the osmolarity, are factors that can cause fluid extravasation through the intima of the vessels so fragile with the consequent accumulation of the same, forming an intrahepatic cavitation that sometimes, by echocardiographic images have been called "abscesses" whose cultures are obviously sterile; but there has been a risk of hemodynamic instability, transient alteration in liver function tests, and surgical drainage of said collection.

For these reasons, I conclude like my predecessors, would also switch to a PICC line.

With kind regards from Guatemala.

https://www.medigraphic.com/pdfs/imi/imi-2020/imi202d.pdf
 

https://www.ajronline.org/doi/pdf/10.2214/ajr.180.4.1801147?download=true

We try to never leave a catheter in a wrong position , mostly if we  have to infuse parenteral nutrition  or any drug thought it. We have 3 cases register in my hospital of babies  that born in others hospitals that have hepatic absceses, and the catheters were intrahepatic. The use of Ultrasound is a very good option. If we urgently needed an IV via we repositioned, but as possibly we look for a PICC line.

We would likely initiate peripheral TPN, either through the UVC pulled back out of the liver shadow (i.e. low-lying) or through a peripheral IV.  Our peripheral TPN is very low concentration Calcium and Phosphate.  Depending on the stability of the infant, we would also insert a PICC line, however, if we could provide adequate nutrition with peripheral TPN, we would often wait until infant reaches 72hrs of age to decrease risk of IVH (limit handling).