Here we demonstrate how one may manipulate the liver and portal venous anatomy to improve vascular alignment and facilitate successful catheterization of the ductus venosus.

Liver manipulation has been well-described as a technique for improving the success of conventional, “blind” UVC placement.

Using ultrasound, the reasons become readily apparent. Titrated liver pressure, directed posteriorly and/or away from the side of catheter malposition, can dramatically improve vascular alignment, favoring passage of the UVC through the ductus venosus while occluding alternative, undesireable channels.

These freeze-frames illustrate the change in vascular alignment that can be accomplished with liver manipulation. The steep S-curve through the portal sinus is flattened.

In this neonate, the UVC repeatedly caught in the left portal vein, seen at top, rather than dropping posteriorly into the portal sinus.

With application of gentle, posteriorly directed liver pressure using the operators imaging hand and US transducer, the left portal vein is compressed and occluded, while the path through the portal sinus to the ductus venosus is flattened and made more favorable. Together, these changes in the vascular anatomy facilitate successful, US-guided placement of umbilical venous catheter.

Using real-time US guidance, the catheter is passed beyond the left portal vein, through the portal sinus, and across the ductus venosus.

The position of the catheter in the low right atrium is then confirmed and adjusted as needed.

Thank you.

"Ultrasound-guided UVC 3_Alignment of Vessels and Cannulation of the Ductus Venosus"
By: Benjamin Kozyak MD ([ Ссылка ])
Creative Commons License: CC BY ([ Ссылка ])

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