Where should a umbilical venous catheter (UVC) tip ideally reside, and what radiographic landmark helps confirm placement?

• A. Tip near the hepatic veins; confirm with ultrasound.
• B. Tip at the level of the diaphragm; confirm with chest/abdominal radiograph showing the tip at the diaphragm.
• C. Tip in the right atrium; confirm with echocardiography.
• D. Tip in the stomach; confirm with abdominal X-ray.

Answer: (B)

Placing the umbilical venous catheter tip at the level of the diaphragm positions the line in the distal inferior vena cava near the cavoatrial junction, which provides reliable central venous access for fluids, medications, and nutrition while minimizing risk. The diaphragmatic level on a neonatal chest/abdominal radiograph is the standard landmark used to confirm this position. If the tip sits too high (in the right atrium) there’s a risk of arrhythmias; if it’s too low (in the hepatic or portal veins) or misdirected into the stomach, infusion can be ineffective or harmful. Therefore, aiming for the diaphragm level and verifying with radiography is the correct approach.