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Updated: Sep 13, 2025
Catheter-based Endovascular Angioplasty for Fibrosing Mediastinitis-associated Pulmonary Vein Stenosis
Published on: August 26, 2025
Analysis of 5 cases of PICC removal difficulty caused by fibroblastic sleeve
1Nursing department, Wuxi Xinwu District Xinrui Hospital (Wuxi branch of Ruijin Hospital Shanghai JiaoTong University School of Medicine), Jiangsu Province, 214028, Wuxi City, China.
Objective:
To explore the difficulties and solutions encountered during the removal of PICC catheters in five patients with a fibroblastic sleeve formation.
Methods:
This study includes five cases of PICC (peripherally inserted central catheter) removal difficulty caused by the formation of a fibroblastic sleeve. The patients were selected from a cohort with two cases involving the basilic vein in the right elbow fossa, two cases involving the brachial vein in the right elbow fossa, and one case involving the right cephalic vein. All patients underwent ultrasonography to exclude phlebitis and thrombosis.
Results:
The fibroblastic sleeve was identified as wrapping around the catheter's tip, leading to significant resistance during removal. The treatment approach involved thrombolysis, specifically using urokinase slowly injected into the catheter, combined with the application of a tourniquet. This method successfully facilitated catheter removal.
Conclusion:
For patients with fibroblastic sleeve formation or catheter adhesion to the vessel wall, applying a tourniquet 11-15 cm above the puncture site may assist in successful PICC removal.
Insights
Difficult peripherally inserted central catheter (PICC) removal due to fibroblastic sleeve formation can be overcome. Thrombolysis with urokinase and tourniquet application successfully facilitated removal in five patients.
Area of Science:
- Vascular Access Management
- Interventional Radiology
- Medical Device Complications
Background:
- Fibroblastic sleeve formation around peripherally inserted central catheters (PICCs) can impede removal.
- This complication necessitates investigation into effective removal strategies.
- Understanding the mechanism of adhesion is crucial for patient care.
Purpose of the Study:
- To investigate difficulties and solutions for PICC removal in patients with fibroblastic sleeve formation.
- To evaluate a specific treatment approach for challenging PICC removals.
- To identify factors aiding successful removal in cases of catheter adhesion.
Main Methods:
- Case series of five patients experiencing difficulty removing PICCs due to fibroblastic sleeves.
- Involved basilic, brachial, and cephalic veins.
- Ultrasonography was used to rule out phlebitis and thrombosis prior to intervention.
Main Results:
- A fibroblastic sleeve wrapping the catheter tip caused significant removal resistance.
- Successful removal was achieved using urokinase thrombolysis and tourniquet application.
- The combined approach addressed the adhesion and facilitated device extraction.
Conclusions:
- Tourniquet application, 11-15 cm above the puncture site, may aid PICC removal.
- This technique is beneficial for fibroblastic sleeve formation or catheter adhesion.
- It offers a practical solution for difficult PICC removals.
