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.

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.

Re-accessing the port made it work and flush properly.

The hematology oncology team wanted the port removed and had set the patient up for a removal and replacement procedure.

An ultrasound suggested there might be some narrowing around the port catheter itself.

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.

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

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

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.

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.