Collection
Vascular Access and Central Lines
Educational content from recorded physician discussions — not medical advice. Always talk to your child's care team about your child's situation.
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The Surfacer works best when there is at least a remnant of vessel that can be traversed, and may be safer than direct needle puncture into the right atrium. — Nathan Fagan, Advanced central venous access techniques for occluded vessels in children · 0:42
Advanced central venous access techniques for occluded vessels in children
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This video explores innovative technologies for central line management, focusing on solutions for blocked superior vena cava (SVC). Dr. Nathan Fagan discusses the MeritMedical Surfacer system for image-guided SVC recanalization via a femor
podcast3:48 · Nov 2026
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, Central line troubleshooting and vascular access preservation in pediatric patients · 2:32
Central line troubleshooting and vascular access preservation in pediatric patients
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Dr. Nathan Fagan, a Pediatric Interventional Radiologist from Akron Children's Hospital, presents a clinical scenario on central line management from the 13th Annual Pediatric Surgery Update Course. He discusses diagnosing and managing a ma
podcast2:57 · Nov 2026
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Central line troubleshooting and vascular access preservation in pediatric patients
The patient was a teenager with a left subclavian dual lumen port and a history of subclavian thrombus that was successfully treated with heparin.
clinicalNathan Fein0:23 ↗
The medial lumen would not flush while the lateral lumen looked fine.
Host summaryJill Knepprath summarizes what Dr. Nathan Fein said — not the host's own clinical position0:31 ↗
The chest X-ray was normal.
Host summaryJill Knepprath summarizes what Dr. Nathan Fein said — not the host's own clinical position0:39 ↗
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.
clinicalNathan Fein0:59 ↗
The issue was that the port just wasn't accessed properly.
Host summaryJill Knepprath summarizes what Dr. Nathan Fein said — not the host's own clinical position1:10 ↗
Re-accessing the port made it work and flush properly.
clinicalNathan Fein1:16 ↗
The hematology oncology team wanted the port removed and had set the patient up for a removal and replacement procedure.
clinicalNathan Fein1:22 ↗
The patient could have gone through an unnecessary procedure just for a poorly accessed port.
Host summaryJill Knepprath summarizes what Dr. Nathan Fein said — not the host's own clinical position1:27 ↗
Premature port removal could have sacrificed future vascular access.
Host summaryJill Knepprath summarizes what Dr. Nathan Fein said — not the host's own clinical position1:32 ↗
An ultrasound suggested there might be some narrowing around the port catheter itself.
clinicalNathan Fein1:37 ↗
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.
clinicalNathan Fein1:40 ↗
Vasculopaths are patients who have no upper and lower central access, no normal access.
clinicalNathan Fein1:54 ↗
Interventional radiology can perform sharp recanalization of the SVC to restore access for vasculopaths.
clinicalNathan Fein2:06 ↗
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.
clinicalNathan Fein2:11 ↗
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.
clinicalNathan Fein2:32 ↗
Before removing a malfunctioning central line, ensure appropriate access first.
Host summaryJill Knepprath summarizes what Dr. Nathan Fein said — not the host's own clinical position2:42 ↗
For patients who have lost central venous access, consult interventional radiology to restore access using specialized techniques.
Host summaryJill Knepprath summarizes what Dr. Nathan Fein said — not the host's own clinical position2:49 ↗
Advanced central venous access techniques for occluded vessels in children
The Surfacer is made by Merritt Medical and provides image-guided SVC recanalization using special equipment.
clinicalNathan Fagan0:29 ↗
The Surfacer requires an open femoral vein, preferably on the right side, to be effective.
Host summaryJill Knepprath summarizes what Dr. Nathan Fagan said — not the host's own clinical position0:36 ↗
The Surfacer works best when there is at least a remnant of vessel that can be traversed, and may be safer than direct needle puncture into the right atrium.
opinionNathan Fagan0:42 ↗
The Surfacer technique involves burying a special catheter at the desired exit site and creating a target at 90 degrees for the expected exit point.
clinicalNathan Fagan0:59 ↗
The X-ray machine is maneuvered so the marker on the catheter aligns with the planned exit point.
Host summaryJill Knepprath summarizes what Dr. Nathan Fagan said — not the host's own clinical position1:08 ↗
A special needle is driven through the catheter that has been pulled up to the skin surface.
clinicalNathan Fagan1:15 ↗
Once the wire exits the skin, through-and-through access is achieved.
Host summaryJill Knepprath summarizes what Dr. Nathan Fagan said — not the host's own clinical position1:21 ↗
The Surfacer technique is suitable for acute pediatric cases as opposed to chronic scarring seen in adult cases.
Host summaryJill Knepprath summarizes what Dr. Nathan Fagan said — not the host's own clinical position1:25 ↗
4D intracardiac echo catheter is a new form of intravascular ultrasound used more commonly in cardiology for ablations or left atrial appendage occlusions.
clinicalNathan Fagan1:32 ↗
The 4D intracardiac echo probe projects an ultrasound wave in 360 degrees.
clinicalNathan Fagan1:48 ↗
The 4D echo image can be reconstructed in any plane to guide the needle across an occlusion.
Host summaryJill Knepprath summarizes what Dr. Nathan Fagan said — not the host's own clinical position1:56 ↗
The technique involves obtaining access from above with normal ultrasound, then using the special catheter to reconstruct images and guide the needle across the occlusion.
clinicalNathan Fagan2:14 ↗
Nobody is currently using 4D intracardiac echo for central line recanalization yet.
clinicalNathan Fagan2:24 ↗
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