Comments.  The reason I selected this article for review was because it illustrates one of the more serious inherant risks of placing umbilical venous catheters (UVCs), namely pericaridal tamponade.  It also illustrates that “optimal” positioning of UVCs at the inferior vena cava – right atrial junction does NOT always prevent this complication.  The authors point out that portions of the IVC are, in fact, intrapericardial.  In order to avoid the risks of pericardial effusions, they recommend placing the UVC tips 1-2cm below the cardiac silouette.  Previous studies have also demonstrated that plain films (both AP and lateral) are not reliable for localizing the position of UVCs (see 4-008).  Echocardiogram with saline contrast injection is a much more reliable method for localizing UVC tip position.  The pericardial effusion described in this case report was picked up on a routine bedside echocardiogram performed by a neonatal fellow before the baby developed any signs or symptoms of cardiac tamponade.  The authors make a good case for training neonatologists in neonatal echocardiography, and routinely screening NICU patients with echocardiograms to assess clinical status and central venous catheter position.  Katumba-Lunyenya¹⁴ and Evans and co-workers from Sydney have shown the usefulness of this skill in hands of neonatal staff, and have developed a CD-based training program for teaching the basics of echocardiography to Neonatologists. (http://www.cs.nsw.gov.au/rpa/neonatal/echo/Echo.html).  ABK