Ultrasound-guided UVC 4_Dual-Catheter Technique for Umbilical Venous Cannulation (Kozyak et al)
Channel: Benjamin Kozyak, MD
Date: 2022-01-27

In this video, we demonstrate how dual-catheter technique (sometimes called “line over line” technique) may be used with real-time US guidance to accomplish successful UVC placement.

In this neonate, a conventional, blind attempts was unsuccessful, and the UVC was left in a low-lying position.

During US-guided placement, the reason for malposition became readily apparent, as a large left portal vein repeatedly swallowed the catheter.  The catheter is seen here lodged in the left portal vein.

Using dual-catheter technique for umbilical venous cannulation, the first catheter is left malpositioned in a problematic portal vein, occupying and obstructing that alternative pathway so that a second catheter may be passed beyond it and to the desired location.

Here you again see the first catheter malpositioned in the large left portal vein, while a second catheter is introduced behind it.  The first catheter is left to occupy the portal vein while the second catheter is advanced beyond it to the ductus venous and right atrium.

X-ray demonstrates both catheters in situ, catheter #1 sits in the left portal vein while catheter #2 has been advanced beyond it into the heart.  Here, the second catheter is deep, with its tip across the foramen ovale in the left atrium.  The first catheter is then removed, taking care not to dislodge the second.  The successfully placed line is then adjusted to the correct position using US, as corroborated by this final radiograph.

Thank you.

"Ultrasound-guided UVC 4_Dual-Catheter Technique for Umbilical Venous Cannulation"
By: Benjamin Kozyak MD (https://www.youtube.com/channel/UCo4gPV2X0y2hx60-RxRLWcQ)
Creative Commons License: CC BY (https://creativecommons.org/licenses/by/4.0/legalcode)