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Pediatrics

Neonatal Tubes and Lines

Endotracheal tube (ETT)

Normal position is above the carina.

Enteric tube

Normal course is into the stomach.

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If you see a coiled enteric tube, consider esophageal atresia

Umbilical venous catheter (UVC)

Normal position is with tip at level of right hemidiaphragm, representing the IVC/right atrial junction.

Normal path: The normal UVC courses from umbilical vein -> left portal vein -> ductus venosus -> left hepatic vein ->IVC/right atrial junction.

Normal variations:

  • ductus venosus bypasses the left hepatic vein and empties directly into the IVC
  • ductus venosus empties into middle hepatic vein

Bad positions: looping back in the umbilical vein, pushing deep into the left portal vein, crossing back to the right portal vein, into the right atrium, crossing a patent foramen ovale or atrial septal defect into the left atrium

Umbilical arterial catheter (UAC)

Normal position is with tip at T8-T10 ("high position") or below L3 ("low position"). High position aims for the descending thoracic aorta.

Bad positions: Intermediate positions of the UAC will threaten branches of the aorta; both high and low positions are considered acceptible.

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UAC versus UVC. UAC courses inferiorly from the umbilicus before coursing superiorly. UVC immediately courses superiorly from the umbilicus.