Umbilical vein catheter malposition: report of one case

A male premature newborn was diagnosed as respiratory distress syndrome shortly after birth. Umbilical arterial and venous catheters were inserted. The position of the umbilical venous catheter was erroneous roentgenographically, but return of blood was noted when the catheter was pull back to below the diaphragm. After fluid infusion via the catheter, swelling of buttock, scrotum and bilateral thighs with pitting edema over the abdominal wall and lower back, and increased body weight were noted the next day. The abdomen was distended without bluish discoloration. Laboratory studies showed neither anemia nor hypoalbuminemia. Blood pressure was 42/28 mmHg. The abdominal reoentgenogram showed bowel gas pattern suggesting the presence of fluid within the peritoneal cavity. The catheter of the umbilical vein was removed. Repeat abdominal reoentgenogram the following day showed resorption of the fluid. The infant was gavage fed. The catheter perforated the umbilical vein and went into the retroperitoneal area. This complication is rare. This case is presented with a review of the literature, concluding that if there are uncertainties about the location of the catheter, verification should include having blood returned from the umbilical venous catheter and taking lateral and frontal films before fluid infusion starts.