# Vascular Access and Central Lines — GCMD Library living collection

Updated: n/a · 2 episodes · 23 cited statements

## Episodes
### Advanced Access Techniques
- [Advanced central venous access techniques for occluded vessels in children](https://library.globalcastmd.com/watch/advanced-central-venous-access-techniques-for-occluded-vessels-in-children-16846) — podcast · 3:48 · [machine version](https://library.globalcastmd.com/watch/advanced-central-venous-access-techniques-for-occluded-vessels-in-children-16846.md)

### Troubleshooting and Preservation
- [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)

## Chapters
- [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 2)
- [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 2)
- [1:32](https://library.globalcastmd.com/watch/central-line-troubleshooting-and-vascular-access-preservation-in-pediatric-patie-16847?t=92) Vascular Access Preservation (Ep 2)
- [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 2)
- [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 2)
- [0:01](https://library.globalcastmd.com/watch/advanced-central-venous-access-techniques-for-occluded-vessels-in-children-16846?t=1) Introduction and series context (Ep 1)
- [0:25](https://library.globalcastmd.com/watch/advanced-central-venous-access-techniques-for-occluded-vessels-in-children-16846?t=25) Surfacer system for SVC recanalization (Ep 1)
- [1:32](https://library.globalcastmd.com/watch/advanced-central-venous-access-techniques-for-occluded-vessels-in-children-16846?t=92) 4D intracardiac echo for guidance (Ep 1)
- [2:34](https://library.globalcastmd.com/watch/advanced-central-venous-access-techniques-for-occluded-vessels-in-children-16846?t=154) Last-resort access: transhepatic vs translumbar (Ep 1)
- [3:19](https://library.globalcastmd.com/watch/advanced-central-venous-access-techniques-for-occluded-vessels-in-children-16846?t=199) Summary of techniques (Ep 1)

## 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/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 2 · 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 2 · 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 2 · 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 2 · 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 2 · 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 2 · 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 2 · 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 2 · 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 2 · 2:32](https://library.globalcastmd.com/watch/central-line-troubleshooting-and-vascular-access-preservation-in-pediatric-patie-16847?t=152)
- The Surfacer is made by Merritt Medical and provides image-guided SVC recanalization using special equipment. — Nathan Fagan (clinical) [Ep 1 · 0:29](https://library.globalcastmd.com/watch/advanced-central-venous-access-techniques-for-occluded-vessels-in-children-16846?t=29)
- 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 (opinion) [Ep 1 · 0:42](https://library.globalcastmd.com/watch/advanced-central-venous-access-techniques-for-occluded-vessels-in-children-16846?t=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. — Nathan Fagan (clinical) [Ep 1 · 0:59](https://library.globalcastmd.com/watch/advanced-central-venous-access-techniques-for-occluded-vessels-in-children-16846?t=59)
- A special needle is driven through the catheter that has been pulled up to the skin surface. — Nathan Fagan (clinical) [Ep 1 · 1:15](https://library.globalcastmd.com/watch/advanced-central-venous-access-techniques-for-occluded-vessels-in-children-16846?t=75)
- 4D intracardiac echo catheter is a new form of intravascular ultrasound used more commonly in cardiology for ablations or left atrial appendage occlusions. — Nathan Fagan (clinical) [Ep 1 · 1:32](https://library.globalcastmd.com/watch/advanced-central-venous-access-techniques-for-occluded-vessels-in-children-16846?t=92)
- The 4D intracardiac echo probe projects an ultrasound wave in 360 degrees. — Nathan Fagan (clinical) [Ep 1 · 1:48](https://library.globalcastmd.com/watch/advanced-central-venous-access-techniques-for-occluded-vessels-in-children-16846?t=108)
- 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. — Nathan Fagan (clinical) [Ep 1 · 2:14](https://library.globalcastmd.com/watch/advanced-central-venous-access-techniques-for-occluded-vessels-in-children-16846?t=134)
- Nobody is currently using 4D intracardiac echo for central line recanalization yet. — Nathan Fagan (clinical) [Ep 1 · 2:24](https://library.globalcastmd.com/watch/advanced-central-venous-access-techniques-for-occluded-vessels-in-children-16846?t=144)
- 4D intracardiac echo catheters are being used more for TIPS procedures, with the premise being whether needles can be guided intravascularly using these special probes. — Nathan Fagan (clinical) [Ep 1 · 2:26](https://library.globalcastmd.com/watch/advanced-central-venous-access-techniques-for-occluded-vessels-in-children-16846?t=146)
- When all traditional central access is lost, transhepatic and translumbar access are last-resort options. — Nathan Fagan (clinical) [Ep 1 · 2:34](https://library.globalcastmd.com/watch/advanced-central-venous-access-techniques-for-occluded-vessels-in-children-16846?t=154)
- There is debate about whether transhepatic or translumbar access is better. — Nathan Fagan (opinion) [Ep 1 · 2:41](https://library.globalcastmd.com/watch/advanced-central-venous-access-techniques-for-occluded-vessels-in-children-16846?t=161)
- Transhepatic access makes the most sense in pediatric patients because if there is bleeding or dislodgement, it is easier to access or control. — Nathan Fagan (opinion) [Ep 1 · 2:43](https://library.globalcastmd.com/watch/advanced-central-venous-access-techniques-for-occluded-vessels-in-children-16846?t=163)
- Translumbar access technique involves locating the IVC at the lumbar level using CT, guiding a needle down to obtain access, and then placing the line. — Nathan Fagan (clinical) [Ep 1 · 3:07](https://library.globalcastmd.com/watch/advanced-central-venous-access-techniques-for-occluded-vessels-in-children-16846?t=187)

## Host summaries
Recaps by a host of what the experts said — not the host's own clinical position.
- The medial lumen would not flush while the lateral lumen looked fine. — Jill Knepprath summarizes what Dr. Nathan Fein said [Ep 2 · 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 2 · 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 2 · 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 2 · 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 2 · 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 2 · 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 2 · 2:49](https://library.globalcastmd.com/watch/central-line-troubleshooting-and-vascular-access-preservation-in-pediatric-patie-16847?t=169)
- The Surfacer requires an open femoral vein, preferably on the right side, to be effective. — Jill Knepprath summarizes what Dr. Nathan Fagan said [Ep 1 · 0:36](https://library.globalcastmd.com/watch/advanced-central-venous-access-techniques-for-occluded-vessels-in-children-16846?t=36)
- The X-ray machine is maneuvered so the marker on the catheter aligns with the planned exit point. — Jill Knepprath summarizes what Dr. Nathan Fagan said [Ep 1 · 1:08](https://library.globalcastmd.com/watch/advanced-central-venous-access-techniques-for-occluded-vessels-in-children-16846?t=68)
- Once the wire exits the skin, through-and-through access is achieved. — Jill Knepprath summarizes what Dr. Nathan Fagan said [Ep 1 · 1:21](https://library.globalcastmd.com/watch/advanced-central-venous-access-techniques-for-occluded-vessels-in-children-16846?t=81)
- The Surfacer technique is suitable for acute pediatric cases as opposed to chronic scarring seen in adult cases. — Jill Knepprath summarizes what Dr. Nathan Fagan said [Ep 1 · 1:25](https://library.globalcastmd.com/watch/advanced-central-venous-access-techniques-for-occluded-vessels-in-children-16846?t=85)
- The 4D echo image can be reconstructed in any plane to guide the needle across an occlusion. — Jill Knepprath summarizes what Dr. Nathan Fagan said [Ep 1 · 1:56](https://library.globalcastmd.com/watch/advanced-central-venous-access-techniques-for-occluded-vessels-in-children-16846?t=116)
- Transhepatic access involves a catheter being directly placed through the liver into the inferior vena cava. — Jill Knepprath summarizes what Dr. Nathan Fagan said [Ep 1 · 2:52](https://library.globalcastmd.com/watch/advanced-central-venous-access-techniques-for-occluded-vessels-in-children-16846?t=172)
- Transhepatic access is a more complicated procedure with higher risk for thrombosis. — Jill Knepprath summarizes what Dr. Nathan Fagan said [Ep 1 · 2:59](https://library.globalcastmd.com/watch/advanced-central-venous-access-techniques-for-occluded-vessels-in-children-16846?t=179)
- Translumbar access involves accessing the inferior vena cava from the back. — Jill Knepprath summarizes what Dr. Nathan Fagan said [Ep 1 · 3:14](https://library.globalcastmd.com/watch/advanced-central-venous-access-techniques-for-occluded-vessels-in-children-16846?t=194)

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