Echocardiographically detected fibrinous sheaths associated with central venous catheters

Several million catheters are annually placed in the United States and worldwide for a multitude of clinical conditions. Potential delayed complications relating to central venous catheters include infections, thrombosis and fibrin sheath formation. Fibrin sheaths form frequently around central catheters but seldom cause clinical symptoms by themselves that warrant further investigation. It is likely that with the advent of echocardiographic imaging techniques, these "sleeves" get detected more often, which may result in early and correct diagnosis of this potential hazardous condition. Retained fibrin sleeves can cause malfunction of indwelling catheters, can persist after removal of the catheter, and be a nidus for thrombus formation or vegetation with a potential for distal embolization. Future research directed at creating new coatings with cytotoxic or cytostatic agents is warranted to reduce the incidence of fibrin sheath formation and hence prevent potential complications. We report three cases of persistent fibrin sheaths forming at the site of previously inserted tunneled catheters two of which were complicated by thrombus formation and vegetations.