Update Course Rewind 2025: Updates in Central Line Management

The patient was a teenager with a left subclavian dual lumen port and a history of subclavian thrombus that was successfully treated with heparin.

The medial lumen of the port would not flush, while the lateral lumen functioned normally.

Fluoroscopic dye study showed contrast welling up around the port and in the pocket itself, not going to the reservoir, when pushing very hard.

The port malfunction was due to improper accessing; re-accessing the port resolved the issue and it flushed normally.

The hematology oncology team wanted the port removed immediately and had scheduled the patient for removal and replacement.

Ultrasound suggested possible narrowing around the port catheter itself.

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.

Vasculopaths are patients who have no upper and lower central access, no normal access.

Interventional radiology can perform sharp recanalization of the SVC for vasculopaths.

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.

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.