Update Course Rewind 2025: New Technologies for Central Line Management

The Surfacer is made by Merritt Medical and is an image-guided SVC recanalization device using special equipment.

The Surfacer works best when there is at least a remnant of the SVC present that can be traversed, and may be safer than direct needle puncture into the right atrium.

4D intracardiac echo catheter is a new form of intravascular ultrasound used more commonly in cardiology for ablations and left atrial appendage occlusions.

The 4D intracardiac echo probe projects an ultrasound wave in 360 degrees and can reconstruct the image in any plane.

The 4D intracardiac echo catheter can be used to guide a needle across an occlusion by reconstructing images in any plane.

Nobody is currently using 4D intracardiac echo for pediatric central line recanalization yet.

4D intracardiac echo catheters are being used more for TIPS procedures, with the premise being intravascular needle guidance using these special probes.

When all traditional central access is lost, transhepatic and translumbar access are last-resort options.

There is debate about whether transhepatic or translumbar access is better.

Transhepatic access makes the most sense in pediatric patients because if there is bleeding or dislodgement, it is easier to access or control.

Translumbar access involves accessing the inferior vena cava from the back, with the IVC located at the lumbar level using CT to guide needle placement.