Update Course Rewind 2025: New Technologies for Central Line Management
With Dr. Nathan Fagan · hosted by Dr. Jill Knepprath
Part of
Thrombosis 4 items
Chapter 1 of 3 · Surgical Management
Surfacer system
Surfacer System for SVC Recanalization
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The Surfacer is made by Merritt Medical and is image guided SVC recannulation using a special piece of equipment.
The Surfacer works best when there is at least a remnant of something there that you can get through.
The Surfacer might be safer than trying to jab a needle down to the right atrium when there is a remnant lumen.
The Surfacer technique involves burying a special catheter where you want your exit site to be and creating a target at 90 degrees where the catheter will exit.
The operator drives a special needle through the catheter that has been pulled up to the skin surface.
4D intracardiac echo catheter is used more in cardiology for ablations or left atrial appendage occlusions.
The 4D intracardiac echo probe projects an ultrasound wave in 360 degrees.
The 4D echo image can be reconstructed in any plane to guide the needle across an occlusion.
The technique involves getting access from above with a normal ultrasound, then using the special 4D catheter to reconstruct and guide the needle across the occlusion.
Nobody is using 4D intracardiac echo for central line recanalization yet.
4D intracardiac echo catheters are being used more for TIPS procedures.
There is a big debate on whether to use transhepatic or translumbar access.
Transhepatic access makes the most sense in pediatric patients because if there is bleeding or if it gets dislodged, it is easier to get to or control.
For translumbar access, the operator locates the IVC at the lumbar level using CT, guides a needle down to get access, and then places the line.
The Surfacer requires an open femoral vein, preferably on the right side, to be effective.
The Surfacer technique is suitable for acute pediatric cases as opposed to the chronic scarring seen in adult cases.
Transhepatic and translumbar access are last resorts when all traditional central access is lost.
Transhepatic access involves a catheter being directly placed through the liver into the inferior vena cava.
Transhepatic access is a more complicated procedure and has higher risk for thrombosis.
Translumbar access involves accessing the inferior vena cava from the back.