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frequency,
have
the factors
exposure
additional
are io ma.,
time of 1/12
io kvp.
to
is added
6o kvp., with
seconds.
for the lateral
i/is
an
An
and recording of their exact position has projection. To reduce radiation exposure
become most important in order to prevent to the infant, paraspeed or highspeed films
American Journal of Roentgenology 1974.120:361-367.
complications and false measurements. are used. The gonads are shielded unless
Catheters are now used in acutely ill in- the pelvic area also needs to be demon-
fants for the above applications, as well as strated on the examination. Rapid evalua-
for hyperalimentation, and the measure- tion of the position of the catheter can also
ment of pressures, electrolytes and blood be obtained with the use of Polaroid film
sugar values. which is developed in a rapid processing
The purpose of this paper is to discuss unit.’
the methods and materials used, the nor- Umbilical catheterization usually can be
mal and abnormal position of catheters, performed in the first days of life. In
and the complications. hypoxic infants, the umbilical vessels may
remain open for a longer period of time, as
MATERIAL AND METHOD
occurred infant
in where
I catheterization
The catheters should be soft, small, and of the umbilical vessels was carried out ii
rigid enough to negotiate the vascular days after birth. The ideal location for the
channels. At the present time, nonwettable, tip of the umbilical artery catheter is at
polyvinyl chloride catheters are in use. We about the 3rd lumbar vertebra, between the
employ a 3.5 French catheter in infants up origin of the renal and superior mesenteric
to 1.5 kg. in weight, and a No. 5 for larger arteries and the bifurcation of the aorta.
infants. The catheter should be radiopaque Another desirable location is in the de-
with an acceptable dead space of less than scending aorta at the D6-7 level, where
0.5 ml. For prevention of clot formation, rapid flow gives good mixing and dilution
the catheter should have an end hole with of injected fluids. The catheter should be
no side holes, and the end should be repositioned to prevent air embolism to
rounded to prevent damage or perforation vital structures when placed in the left
of the vascular wall. common carotid artery, the innominate
Localization can be achieved by image artery, the external iliac artery, the femoral
intensification fluoroscopy or by antero- artery, or the pulmonary artery (reached
posterior (AP) and lateral roentgeno- via the ductus arteriosus).
graphic examination of the chest and abdo- The technique of umbilical venous cath-
men. In the Newborn Intensive Care Unit eterization is the same as that used for ar-
* From the Departments of Radiology and Pediatrics, Harvard Medical School and Massachusetts General Hospital, Boston,
Massachusetts.
361
362 A. L. \Veber, S. DeLuca and D. C. Shannon FEBRUARY, 1974
FIG. 2. (A) Anteroposterior and (B) lateral roentgenograms of the chest and abdomen
demonstrating normal course and position of umbilical venous catheter.
VOL. 120, No. 2 Normal and Abnormal Position of the Umbilical Artery 363
tinued monitoring, a catheter can be used the liver through the ductus venosus into
safely for as long as I week. If an alternate the inferior vena cava. The umbilical artery
site for monitoring arterial blood pressures, catheter passes medially, inferiorly, and
gases, and electrolytes becomes necessary, forms a ioop before entering the hypogas-
a 20-22 gauge teflon-covered cannula can tric arteries, and then ascends within the
be placed in a radial, dorsalis pedis, or tem- aorta to the left and anterior of the lumbar
poral artery. spine (Fig. 3, 4 and B).
In view of the relatively slow flow in a
COMPLICATIONS FOLLOWING PASSAGE OF
peripheral artery, no medications, hyper-
UMBILICAL ARTERY OR
tonic solutions, or albumin should be in-
VENOUS CATHETERS
jected. The same sampling, pressure moni-
toring, and flushing procedures can be em- In order to prevent complications or
ployed as described above. With careful false measurements, accurate position of
handling, the peripheral artery can be ex- the catheter, sterile technique, gentle ma-
pected to remain serviceable for 5 to 7 days. neuvering of the catheter, and flushing of
As soon as the umbilical artery or venous the catheter should be strictly adhered to.
catheter is in place, AP and lateral roent- A catheter positioned in the inferior vena
genograms of the abdomen and chest cava can measure central venous pressure
American Journal of Roentgenology 1974.120:361-367.
should be obtained for accurate localiza- which is a reflection of the vascular volume.
tion.3”6 In the
view theAP venous Measurement of portal venous pressure,
catheter ascends slightly
to the right at the however, is always higher than central
level of the ductus (Fig. 2, A’ and B). In venous pressure, and therefore cannot be
the lateral view, the catheter ascends be- used for evaluating the general cardiovas-
neath the rectus muscle posteriorly within cular status.2
FiG. 3. (A) Anteroposterior and (B) lateral roentgenograms of the chest and abdomen
demonstrating normal course and position of arterial catheter.
364 A. L. \Veber, S. DeLuca and D. C. Shannon FEBRUARY, 1974
20
FIG. 5. (A) Anteroposterior and (B) lateral roentgenograms of the abdomen showing
umbilical vein catheter coiled at the level of ductus venosus.
VOL. 120, No. 2 Normal and Abnormal Position of the Umbilical Artery 365
I iG. 6. (A) Anteroposterior and (B) lateral roentgenograms of the chest revealing the tip of umbilical vein
American Journal of Roentgenology 1974.120:361-367.
catheter in the left atrium after passage through patent foramen ovale.
FIG. 7. (A) Anteroposterior and (B) lateral roentgenograms of the chest including neck show-
ing the umbilical vein catheter in the left lugular vein after crossing the right atrium.
366 A. L. Weber, S. DeLuca and D. C. Shannon FEBRUARY, 1974
DISCUSSION
toring techniques will permit the physician Proper localization of umbilical arterial and
venous catheters by lateral roentgenograms.
to manage these infants with less risk. Ac-
Pediatrics, 1969, 43, 34-39.
curate placement of the catheters is of ut- 4. BRAUNE, M., and HEIMING, E. Report IXth
most importance to prevent complications Annual Meeting of the European Society of
and obtain accurate blood measurements. Pediatric Radiology, Paris, 1972, pp. 10-13.
We recommend AP and lateral roentgeno- 5. CAMPBELL, R. E. Roentgenologic features of
umbilical vascular catheterization in newborn.
grams of the chest and abdomen to assure
AM. J. ROENTGENOL., & RAD. THERAPY
correct localization of the arterial or venous
NUCLEAR MED., 68-76.1971, 112,
catheter. A portable x-ray machine in the 6. CASTOR, W. R. Spontaneous perforation of bowel
intensive care unit is adequate, but a built- in newborn following exchange transfusion.
in unit is preferable. The latter unit allows Canad. M. A. 7., 1968, 99, 934-939.
conventional roentgenographic technique, 7. COCHRAN, W. D., DAVIS, H. T., and SMITH,
C. A. Advantages and complications of urn-
magnification studies of the lung, and cath-
bilical artery catheterization in newborn.
eterization of the umbilical artery and vein Pediatrics, 1968, 42, 769-777.
on the roentgenographic table. For rapid 8. DIAMOND, L. K. Erythroblastosis foetalis or
localization of the catheter alone, Polaroid haemolytic disease ofnewborn. Proc. Roy. Soc.
In addition to localization of vascular 9. DIAMOND, L. K., ALLEN, F. H., JR., and THOMAS,
American Journal of Roentgenology 1974.120:361-367.