Risk of complications is high (10–50%). Keep the catheter tip in the ductus venosus or inferior vena cava and not at the foramen ovale, portal vein, or hepatic vein. Remember, you can have complications from appropriately placed UVC.
Infection. The most commonly reported adverse effect. Minimize the risk by strict sterile technique, never advancing a catheter that has already been positioned, and limiting indwelling time. Sepsis is the most common, cellulitis, omphalitis, endocarditis, septic emboli, liver abscess, and lung abscess (with malposition of UVC into right pulmonary vein). AAP recommends to remove and not replace the line if any signs of central line–associated bloodstream infection are present.
Cardiac complications. Pericardial effusion is the second most common complication. It can be asymptomatic and suspected in infants with catheters and progressive cardiomegaly. Right atrial arrhythmias can be caused by a UVC inserted too far and irritates the heart. Cardiac tamponade, cardiac perforation, pneumopericardium, and thrombotic endocarditis have also been reported.
Thrombotic or embolic phenomenon. The most important risk factor is placement of central catheters. Never allow air to enter the end of the catheter. A nonfunctioning catheter should be removed. Never try to flush clots from the end of the catheter. Emboli can be in the lungs (if catheter passes through ductus venosus), liver, (catheter at portal system and ductus venous is closed), or anywhere in systemic circulation (catheter is through the ductus venosus, and there is right to left shunting through the ductus arteriosus or foramen ovale). Careful monitoring is indicated in very low birthweight infants who have a hematocrit >55% in the first week of life, as there is an increase in UVC-associated thrombosis in this group. AAP recommends removing the line if thrombosis is present.
Blood loss/hemorrhage. Occurs if tubing becomes disconnected (use Luer lock connections).
Retroperitoneal fluid extravasation (genital, buttocks, thigh, abdominal), total parenteral nutrition/IV fluid, ascites, hemoperitoneum.
Necrotizing enterocolitis. Thought to be a complication of UVCs, especially if left in place for >24 hours.
Fungal infections of the right atrium. Reported complication of 13%.
Pulmonary edema, hemorrhage, infarction (with/without hydrothorax), hydrothorax can occur from a catheter lodged in or perforated pulmonary vein.
Portal vein hypertension. Caused by a catheter positioned in the portal system.
Hepatic complications include necrosis, calcification, laceration, abscess, biliary venous fistula formation, infusate ascites, subcapsular fluid collections, and portal venous air/hematoma/erosion. Do not allow a catheter to remain in the portal system. In case of emergency placement, the catheter should be advanced only 2–3 cm (just until blood returns) to avoid hepatic infusion. If the UVC perforates an intrahepatic vascular wall, a hematoma may result.
Other rare complications. Creation of a false luminal tract, vessel perforation, hydrothorax, hepatic cyst, digital ischemia, perforation of the peritoneum, hemorrhagic infarction of the lungs, colon perforation, perforation of the Meckel diverticulum (UVC inserted through a narrow lumen in the umbilical cord mistaken for an umbilical vein), persistent neonatal hypoglycemia, ascites with peritoneal perforation), fluid in the peritoneal cavity from a perforated umbilical vein, Wharton jelly embolism, gangrene of the extremity (UVC placed in iliac artery branches).