Evaluation of umbilical catheter and tube placement in premature infants.

Umbilical arterial and venous catheters, endotracheal tubes, and nasogastric tubes are routinely used in treating premature infants, and radiologists play a critical role in evaluating proper catheter and tube placement and recognizing potential complications. Ideally, an umbilical venous catheter should be positioned in the right atrium; an umbilical arterial catheter, between T-6 and T-10 (high position) or between L-3 and L-5 (low position); an endotracheal tube, 1.5 cm above the carina, with the infant's head in a neutral position; and a nasogastric tube, in the body of the stomach. Catheters and tubes can be malpositioned in a variety of vessels and the main stem bronchi, respectively. Complications include extraluminal placement of catheters (which can result in death), thrombi in the aorta and pulmonary artery, aortic aneurysm, subglottic stenosis, intubation granuloma, and perforation of the esophagus and stomach.