Umbilical venous catheter

# Overview
Umbilical venous catheters are commonly used in the neonatal period for vascular access. An umbilical venous catheter passes through the umbilicus, umbilical vein, left portal vein, ductus venosus, middle or left hepatic vein, and inferior vena cava to the junction of the inferior vena cava with the right atrium. In contrast, the typically paired, bilateral umbilical arteries initially course caudally to enter the right and left iliac arteries. Therefore, the umbilical venous catheter and the umbilical artery catheter can be easily distinguished on abdominal radiographs. The umbilical venous catheter predominantly follows an anterior and cephalad course in the midline umbilical vein until directed posteriorly in the liver. The umbilical artery catheter is initially directed caudally and posteriorly to enter either the right or left iliac artery before coursing superiorly in the more posteriorly positioned aorta. The preferred location of the tip of the umbilical venous catheter is typically in the cephalad portion of the inferior vena cava or at the inferior vena cavalright atrial junction.

# Anomalous positioning of Umbilical venous catheter
- Anomalous positioning of the umbilical venous catheter occurs frequently because the catheter is inserted by the pediatrician without imaging guidance.
- If the umbilical venous catheter follows the normal course to the inferior vena cava or right atrium but is advanced too far, the umbilical venous catheter may extend through a  patent foramen ovale or an atrial septal defect into the left atrium or, if advanced farther, into a pulmonary vein. Alternatively, the catheter may continue through the right atrium and into the superior vena cava or may cross the tricuspid valve and enter the right ventricle. If advanced, the umbilical venous catheter may continue into the main, right, or left pulmonary artery.
If the umbilical venous catheter reaches the left portal vein but does not continue into the ductus venosus, the catheter can travel left into the more peripheral left portal vein or right, where it can eventually course into the right portal vein or hepatofugally into the main portal vein (or potentially farther into the vessels that merge to form the portal vein: the superior mesenteric and splenic veins).
- If the umbilical venous catheter follows the normal course to the inferior vena cava or right atrium but is advanced too far, the umbilical venous catheter may extend through a  patent foramen ovale or an atrial septal defect into the left atrium or, if advanced farther, into a pulmonary vein. Alternatively, the catheter may continue through the right atrium and into the superior vena cava or may cross the tricuspid valve and enter the right ventricle. If advanced, the umbilical venous catheter may continue into the main, right, or left pulmonary artery.
- If the umbilical venous catheter reaches the left portal vein but does not continue into the ductus venosus, the catheter can travel left into the more peripheral left portal vein or right, where it can eventually course into the right portal vein or hepatofugally into the main portal vein (or potentially farther into the vessels that merge to form the portal vein: the superior mesenteric and splenic veins).

# Complications of Umbilical venous catheter
- If the umbilical venous catheter perforates an intrahepatic vascular wall, a hepatic hematoma may result.
- Intravascular thrombi may form along the course of the umbilical venous catheter.
- The umbilical venous catheter can also perforate the right or left atrial wall and enter the pericardial space.