# Subclavian Thrombus — GCMD Library living collection

Everything in the library about subclavian thrombus — built automatically from dossiers that name it.

Updated: n/a · 3 episodes · 35 cited statements

## Episodes
### Case-Based Learning
- [Update Course Rewind 2025: Updates in Central Line Management](https://library.globalcastmd.com/watch/update-course-rewind-2025-updates-in-central-line-management-12531) — video · 2:57 · [machine version](https://library.globalcastmd.com/watch/update-course-rewind-2025-updates-in-central-line-management-12531.md)
- [Central line troubleshooting and vascular access preservation in pediatric patients](https://library.globalcastmd.com/watch/central-line-troubleshooting-and-vascular-access-preservation-in-pediatric-patie-16847) — podcast · 2:57 · [machine version](https://library.globalcastmd.com/watch/central-line-troubleshooting-and-vascular-access-preservation-in-pediatric-patie-16847.md)

### In-Depth Reviews
- [2025 Pediatric Surgery Update Course - Updates in Central Line Management](https://library.globalcastmd.com/watch/2025-pediatric-surgery-update-course-updates-in-central-line-management-10898) — video · 25:42 · [machine version](https://library.globalcastmd.com/watch/2025-pediatric-surgery-update-course-updates-in-central-line-management-10898.md)

## Chapters
- [0:00](https://library.globalcastmd.com/watch/2025-pediatric-surgery-update-course-updates-in-central-line-management-10898?t=0) Introduction and Case: Non-Flushing Port (Ep 1)
- [4:00](https://library.globalcastmd.com/watch/2025-pediatric-surgery-update-course-updates-in-central-line-management-10898?t=240) Sharp Recanalization of SVC Occlusion (Ep 1)
- [9:10](https://library.globalcastmd.com/watch/2025-pediatric-surgery-update-course-updates-in-central-line-management-10898?t=550) Thoracic Azygos Approach (Ep 1)
- [13:03](https://library.globalcastmd.com/watch/2025-pediatric-surgery-update-course-updates-in-central-line-management-10898?t=783) New Technologies: Surface EKG and ICE (Ep 1)
- [21:54](https://library.globalcastmd.com/watch/2025-pediatric-surgery-update-course-updates-in-central-line-management-10898?t=1314) Transhepatic and Translumbar Access (Ep 1)
- [0:08](https://library.globalcastmd.com/watch/update-course-rewind-2025-updates-in-central-line-management-12531?t=8) Case Presentation: Malfunctioning Port with Normal Chest X-ray (Ep 2)
- [1:32](https://library.globalcastmd.com/watch/update-course-rewind-2025-updates-in-central-line-management-12531?t=92) Preserving Future Vascular Access (Ep 2)
- [1:48](https://library.globalcastmd.com/watch/update-course-rewind-2025-updates-in-central-line-management-12531?t=108) Management of Vasculopaths and Sharp SVC Recanalization (Ep 2)
- [2:42](https://library.globalcastmd.com/watch/update-course-rewind-2025-updates-in-central-line-management-12531?t=162) Summary and Key Takeaways (Ep 2)
- [0:01](https://library.globalcastmd.com/watch/central-line-troubleshooting-and-vascular-access-preservation-in-pediatric-patie-16847?t=1) Introduction and Series Context (Ep 3)
- [0:23](https://library.globalcastmd.com/watch/central-line-troubleshooting-and-vascular-access-preservation-in-pediatric-patie-16847?t=23) Case Presentation: Malfunctioning Port (Ep 3)
- [1:32](https://library.globalcastmd.com/watch/central-line-troubleshooting-and-vascular-access-preservation-in-pediatric-patie-16847?t=92) Vascular Access Preservation (Ep 3)
- [1:48](https://library.globalcastmd.com/watch/central-line-troubleshooting-and-vascular-access-preservation-in-pediatric-patie-16847?t=108) Interventional Radiology Techniques for Vasculopaths (Ep 3)
- [2:42](https://library.globalcastmd.com/watch/central-line-troubleshooting-and-vascular-access-preservation-in-pediatric-patie-16847?t=162) Summary and Key Takeaways (Ep 3)

## Statements
Every statement is attributed, typed, and timestamped; the link is the citation.
- The patient was a teenager with a left subclavian dual lumen port and a history of subclavian thrombus that was successfully treated with heparin. — Nathan Fein (clinical) [Ep 2 · 0:23](https://library.globalcastmd.com/watch/update-course-rewind-2025-updates-in-central-line-management-12531?t=23)
- The medial lumen of the port would not flush, while the lateral lumen functioned normally. — Nathan Fein (clinical) [Ep 2 · 0:31](https://library.globalcastmd.com/watch/update-course-rewind-2025-updates-in-central-line-management-12531?t=31)
- Fluoroscopic dye study showed contrast welling up around the port and in the pocket itself, not going to the reservoir, when pushing very hard. — Nathan Fein (clinical) [Ep 2 · 0:59](https://library.globalcastmd.com/watch/update-course-rewind-2025-updates-in-central-line-management-12531?t=59)
- The port malfunction was due to improper accessing; re-accessing the port resolved the issue and it flushed normally. — Nathan Fein (clinical) [Ep 2 · 1:10](https://library.globalcastmd.com/watch/update-course-rewind-2025-updates-in-central-line-management-12531?t=70)
- The hematology oncology team wanted the port removed immediately and had scheduled the patient for removal and replacement. — Nathan Fein (clinical) [Ep 2 · 1:22](https://library.globalcastmd.com/watch/update-course-rewind-2025-updates-in-central-line-management-12531?t=82)
- Ultrasound suggested possible narrowing around the port catheter itself. — Nathan Fein (clinical) [Ep 2 · 1:37](https://library.globalcastmd.com/watch/update-course-rewind-2025-updates-in-central-line-management-12531?t=97)
- If you pull the port catheter out in the setting of vessel narrowing, you have not lost any potential access for interventional radiology to work to maintain it. — Nathan Fein (opinion) [Ep 2 · 1:40](https://library.globalcastmd.com/watch/update-course-rewind-2025-updates-in-central-line-management-12531?t=100)
- Vasculopaths are patients who have no upper and lower central access, no normal access. — Nathan Fein (clinical) [Ep 2 · 1:54](https://library.globalcastmd.com/watch/update-course-rewind-2025-updates-in-central-line-management-12531?t=114)
- Interventional radiology can perform sharp recanalization of the SVC for vasculopaths. — Nathan Fein (clinical) [Ep 2 · 2:06](https://library.globalcastmd.com/watch/update-course-rewind-2025-updates-in-central-line-management-12531?t=126)
- Sharp SVC recanalization uses ultrasound to visualize the jugular vein and a combination of fluoroscopy and ultrasound to guide a small needle through the area of stenosis, through the SVC beyond the stenosis, and into the right atrium. — Nathan Fein (clinical) [Ep 2 · 2:11](https://library.globalcastmd.com/watch/update-course-rewind-2025-updates-in-central-line-management-12531?t=131)
- In sharp SVC recanalization, the interventionist can approach from below via the femoral vein to drive a needle through a target to connect the two sides, then perform balloon angioplasty, stent placement, and line placement. — Nathan Fein (clinical) [Ep 2 · 2:29](https://library.globalcastmd.com/watch/update-course-rewind-2025-updates-in-central-line-management-12531?t=149)
- A teenager with a left subclavian dual-lumen port had a history of subclavian thrombus successfully treated with heparin, but the medial lumen would not flush while the lateral lumen functioned normally. — Nathan Fagan (clinical) [Ep 1 · 1:18](https://library.globalcastmd.com/watch/2025-pediatric-surgery-update-course-updates-in-central-line-management-10898?t=78)
- The non-flushing port was found to be simply not accessed correctly; re-accessing it allowed it to flush normally without any other intervention. — Nathan Fagan (clinical) [Ep 1 · 4:00](https://library.globalcastmd.com/watch/2025-pediatric-surgery-update-course-updates-in-central-line-management-10898?t=240)
- Removing and replacing a port for access issues without fluoroscopic evaluation risks losing potential future access sites and may contribute to the cascade creating 'vasculopath' patients with no upper or lower central access. — Nathan Fagan (opinion) [Ep 1 · 4:30](https://library.globalcastmd.com/watch/2025-pediatric-surgery-update-course-updates-in-central-line-management-10898?t=270)
- Sharp recanalization of the SVC can be performed using ultrasound to visualize the jugular vein and a combination of fluoroscopy and ultrasound to guide a small needle through the stenosis into the right atrium. — Nathan Fagan (clinical) [Ep 1 · 6:40](https://library.globalcastmd.com/watch/2025-pediatric-surgery-update-course-updates-in-central-line-management-10898?t=400)
- Two techniques for sharp recanalization include: (1) using a contrast-filled circle as a target from above while advancing a needle from the femoral vein below, and (2) inflating a contrast-filled balloon from below as a target for needle puncture. — Nathan Fagan (clinical) [Ep 1 · 7:20](https://library.globalcastmd.com/watch/2025-pediatric-surgery-update-course-updates-in-central-line-management-10898?t=440)
- The thoracic azygos approach for central access involves staying anterior and lateral to the carotid artery, using ultrasound guidance, and is described as similar to laparoscopic inguinal hernia repair in technique. — Nathan Fagan (clinical) [Ep 1 · 10:13](https://library.globalcastmd.com/watch/2025-pediatric-surgery-update-course-updates-in-central-line-management-10898?t=613)
- The Surface EKG system by Merit Medical allows image-guided SVC recanalization by advancing a catheter from the femoral vein to the occlusion site, defining a target exit point, and driving a needle through the catheter to create through-and-through access. — Nathan Fagan (clinical) [Ep 1 · 13:03](https://library.globalcastmd.com/watch/2025-pediatric-surgery-update-course-updates-in-central-line-management-10898?t=783)
- The Surface EKG technique works best when there is at least a remnant of vessel present to traverse, rather than complete chronic occlusion. — Nathan Fagan (opinion) [Ep 1 · 14:10](https://library.globalcastmd.com/watch/2025-pediatric-surgery-update-course-updates-in-central-line-management-10898?t=850)
- Intracardiac echocardiography (ICE) catheters project ultrasound waves 360 degrees and can reconstruct images in any plane, potentially allowing safer guidance of needles across vascular occlusions. — Nathan Fagan (clinical) [Ep 1 · 15:50](https://library.globalcastmd.com/watch/2025-pediatric-surgery-update-course-updates-in-central-line-management-10898?t=950)
- Traditional ICE catheters are 10 French, newer versions are 8 French, and some can be used in 7.5 French sheaths; 10 French is difficult in pediatric patients but 8 French is more feasible. — Nathan Fagan (clinical) [Ep 1 · 18:20](https://library.globalcastmd.com/watch/2025-pediatric-surgery-update-course-updates-in-central-line-management-10898?t=1100)
- When dilating across tight vascular occlusions, balloons are used rather than traditional dilators, starting with small cardiac balloons (5mm) and progressively increasing size. — Nathan Fagan (clinical) [Ep 1 · 20:00](https://library.globalcastmd.com/watch/2025-pediatric-surgery-update-course-updates-in-central-line-management-10898?t=1200)
- Transhepatic access may be easier to control if bleeding occurs or the catheter dislodges, particularly in pediatric patients, but weak evidence suggests higher thrombosis rates compared to translumbar access. — Nathan Fagan (clinical) [Ep 1 · 21:54](https://library.globalcastmd.com/watch/2025-pediatric-surgery-update-course-updates-in-central-line-management-10898?t=1314)
- Two patients with transhepatic catheters experienced dislodgement into the peritoneal cavity due to respiratory movement, resulting in TPA infusion into the abdomen and severe complications. (clinical) [Ep 1 · 23:40](https://library.globalcastmd.com/watch/2025-pediatric-surgery-update-course-updates-in-central-line-management-10898?t=1420)
- Translumbar catheter dislodgement results in retroperitoneal bleeding which may be contained by muscle, whereas transhepatic dislodgement causes hemoperitoneum. (clinical) [Ep 1 · 24:30](https://library.globalcastmd.com/watch/2025-pediatric-surgery-update-course-updates-in-central-line-management-10898?t=1470)
- The patient was a teenager with a left subclavian dual lumen port and a history of subclavian thrombus that was successfully treated with heparin. — Nathan Fein (clinical) [Ep 3 · 0:23](https://library.globalcastmd.com/watch/central-line-troubleshooting-and-vascular-access-preservation-in-pediatric-patie-16847?t=23)
- When pushing contrast very hard, there was just a little bit of contrast welling up around the port and in the pocket itself and not actually going to the reservoir. — Nathan Fein (clinical) [Ep 3 · 0:59](https://library.globalcastmd.com/watch/central-line-troubleshooting-and-vascular-access-preservation-in-pediatric-patie-16847?t=59)
- Re-accessing the port made it work and flush properly. — Nathan Fein (clinical) [Ep 3 · 1:16](https://library.globalcastmd.com/watch/central-line-troubleshooting-and-vascular-access-preservation-in-pediatric-patie-16847?t=76)
- The hematology oncology team wanted the port removed and had set the patient up for a removal and replacement procedure. — Nathan Fein (clinical) [Ep 3 · 1:22](https://library.globalcastmd.com/watch/central-line-troubleshooting-and-vascular-access-preservation-in-pediatric-patie-16847?t=82)
- An ultrasound suggested there might be some narrowing around the port catheter itself. — Nathan Fein (clinical) [Ep 3 · 1:37](https://library.globalcastmd.com/watch/central-line-troubleshooting-and-vascular-access-preservation-in-pediatric-patie-16847?t=97)
- If you just pull the port catheter out when there is narrowing, you have not lost any potential access for interventional radiology to work together to maintain it. — Nathan Fein (clinical) [Ep 3 · 1:40](https://library.globalcastmd.com/watch/central-line-troubleshooting-and-vascular-access-preservation-in-pediatric-patie-16847?t=100)
- Vasculopaths are patients who have no upper and lower central access, no normal access. — Nathan Fein (clinical) [Ep 3 · 1:54](https://library.globalcastmd.com/watch/central-line-troubleshooting-and-vascular-access-preservation-in-pediatric-patie-16847?t=114)
- Interventional radiology can perform sharp recanalization of the SVC to restore access for vasculopaths. — Nathan Fein (clinical) [Ep 3 · 2:06](https://library.globalcastmd.com/watch/central-line-troubleshooting-and-vascular-access-preservation-in-pediatric-patie-16847?t=126)
- The basic technique for sharp SVC recanalization uses ultrasound to look at the jugular vein and then some combination of fluoro and ultrasound to guide a really tiny needle through the area of stenosis and through the SVC beyond the stenosis and into the right atrium. — Nathan Fein (clinical) [Ep 3 · 2:11](https://library.globalcastmd.com/watch/central-line-troubleshooting-and-vascular-access-preservation-in-pediatric-patie-16847?t=131)
- The interventionist can come from below from the femoral vein to drive a needle through a target to connect the two, perform balloon plasty and stent, and then place the line. — Nathan Fein (clinical) [Ep 3 · 2:32](https://library.globalcastmd.com/watch/central-line-troubleshooting-and-vascular-access-preservation-in-pediatric-patie-16847?t=152)

## Host summaries
Recaps by a host of what the experts said — not the host's own clinical position.
- The chest X-ray was normal. — Jill Knepprath summarizes what Dr. Nathan Fein said [Ep 2 · 0:39](https://library.globalcastmd.com/watch/update-course-rewind-2025-updates-in-central-line-management-12531?t=39)
- An unnecessary port removal procedure could have sacrificed future vascular access. — Jill Knepprath summarizes what Dr. Nathan Fein said [Ep 2 · 1:27](https://library.globalcastmd.com/watch/update-course-rewind-2025-updates-in-central-line-management-12531?t=87)
- Before removing a malfunctioning central line, ensure appropriate access first. — Jill Knepprath summarizes what Dr. Nathan Fein said [Ep 2 · 2:42](https://library.globalcastmd.com/watch/update-course-rewind-2025-updates-in-central-line-management-12531?t=162)
- For patients who have lost central venous access, consult interventional radiology to restore access using specialized techniques. — Jill Knepprath summarizes what Dr. Nathan Fein said [Ep 2 · 2:49](https://library.globalcastmd.com/watch/update-course-rewind-2025-updates-in-central-line-management-12531?t=169)
- The medial lumen would not flush while the lateral lumen looked fine. — Jill Knepprath summarizes what Dr. Nathan Fein said [Ep 3 · 0:31](https://library.globalcastmd.com/watch/central-line-troubleshooting-and-vascular-access-preservation-in-pediatric-patie-16847?t=31)
- The chest X-ray was normal. — Jill Knepprath summarizes what Dr. Nathan Fein said [Ep 3 · 0:39](https://library.globalcastmd.com/watch/central-line-troubleshooting-and-vascular-access-preservation-in-pediatric-patie-16847?t=39)
- The issue was that the port just wasn't accessed properly. — Jill Knepprath summarizes what Dr. Nathan Fein said [Ep 3 · 1:10](https://library.globalcastmd.com/watch/central-line-troubleshooting-and-vascular-access-preservation-in-pediatric-patie-16847?t=70)
- The patient could have gone through an unnecessary procedure just for a poorly accessed port. — Jill Knepprath summarizes what Dr. Nathan Fein said [Ep 3 · 1:27](https://library.globalcastmd.com/watch/central-line-troubleshooting-and-vascular-access-preservation-in-pediatric-patie-16847?t=87)
- Premature port removal could have sacrificed future vascular access. — Jill Knepprath summarizes what Dr. Nathan Fein said [Ep 3 · 1:32](https://library.globalcastmd.com/watch/central-line-troubleshooting-and-vascular-access-preservation-in-pediatric-patie-16847?t=92)
- Before removing a malfunctioning central line, ensure appropriate access first. — Jill Knepprath summarizes what Dr. Nathan Fein said [Ep 3 · 2:42](https://library.globalcastmd.com/watch/central-line-troubleshooting-and-vascular-access-preservation-in-pediatric-patie-16847?t=162)
- For patients who have lost central venous access, consult interventional radiology to restore access using specialized techniques. — Jill Knepprath summarizes what Dr. Nathan Fein said [Ep 3 · 2:49](https://library.globalcastmd.com/watch/central-line-troubleshooting-and-vascular-access-preservation-in-pediatric-patie-16847?t=169)

## Changelog
- Nov 11: 3 items added automatically

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