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Published on: January 24, 2012
Fibrin sheath removal from central venous catheters: an internal snare manoeuvre
Arra S Reddy1, Elvira V Lang, Jennifer Cutts
1Beth Israel Deaconess Medical Center, One Deaconess Road, Room 327C, Boston, MA 02215, USA.
Insights
A novel internal snare technique effectively restores patency in thrombosed haemodialysis catheters by removing thrombi and fibrin sheaths. This minimally invasive approach offers a safe and efficient solution for catheter dysfunction, improving patient outcomes.
Area of Science:
- Nephrology
- Vascular Access
- Minimally Invasive Procedures
Background:
- Haemodialysis catheter dysfunction commonly results from lumen narrowing or fibrin sheath formation.
- Existing methods for restoring catheter patency have limitations.
- A new technique addresses thrombi and debris removal while stripping the fibrin sheath.
Purpose of the Study:
- To present a minimally invasive technique for restoring patency to partially thrombosed haemodialysis catheters.
- To evaluate the efficacy and safety of the internal snare technique.
Main Methods:
- A nitinol wire is shaped into a loop and inserted into the catheter lumen.
- The snare opens upon exiting the catheter, disrupting the fibrin sheath and capturing intraluminal thrombi and debris.
- The procedure requires no anesthesia or recovery time.
Main Results:
- The technique achieved 100% initial clinical success in restoring target haemodialysis flow rates (7/7 patients).
- No complications were reported in any patients.
- Sustained primary success rates of 100% were observed at 2, 4, and 6 weeks.
Conclusions:
- The internal snare technique is an effective, inexpensive, and minimally invasive method for restoring patency to failed central venous access catheters.
- This approach offers a promising solution for managing haemodialysis catheter dysfunction.
Background:
Dysfunction of haemodialysis catheters is most commonly due to a narrowing of the catheter lumen and/or formation of a fibrin sheath around the catheter tip. Reported methods for restoring patency of the catheter lumen include passage of a J-tipped guide wire, passage of a biopsy brush through the catheter, or infusion of a thrombolytic agent into the catheter. While these methods are often effective, they suffer from several limitations. We present a minimally invasive technique to remove thrombi and debris from within the lumen of a partially thrombosed haemodialysis catheter while simultaneously stripping the fibrous sheath.
Methods:
A 0.089 cm nitinol wire is bent to create a loop, which is then inserted via the catheters. Upon exiting the lumen of the catheters, the nitinol wire forces a snare open, which disrupts the fibrin sheath and catches intraluminal thrombi and debris. The technique requires no anaesthesia or recovery time.
Results:
Initial clinical success in our series was achieved in all patients (7/7) as evidenced by restoration of target flow rates on subsequent haemodialysis. None of the patients experienced any complications as a result of the procedure. The catheter 2-, 4-, and 6-week primary success rates were 100% (8/8), 100% (8/8), and 100% (8/8) respectively with a mean duration of 17.1 weeks (range 8-40 weeks).
Conclusions:
The internal snare technique is an effective, inexpensive and minimally invasive approach to restoring patency to failed central venous access catheters.
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