Fibrin sheath formation and chemotherapy extravasation: a case report

Area of Science:

• Vascular Access Device Management
• Thrombotic Complications
• Medical Device Safety

Background:

• Persistent withdrawal occlusion (PWO) is a frequent complication associated with venous access devices (VADs).
• Fibrin sheath formation is a common cause of PWO, often manageable with thrombolytic therapy.
• Untreated PWO can escalate to severe issues, including chemotherapy extravasation.

Observation:

• This retrospective case report details a patient experiencing drug extravasation.
• The extravasation was directly linked to the development of a fibrin sheath around the VAD.
• Failure of standard thrombolytic therapy necessitated further investigation.

Findings:

• Fibrin sheath formation around VADs can lead to persistent withdrawal occlusion.
• Persistent withdrawal occlusion, if not resolved, poses a risk for serious complications such as extravasation.
• Catheter dye studies are crucial for diagnosing fibrin sheath formation when thrombolytic therapy fails.

Implications:

• Vigilant assessment of VADs is essential for early detection of fibrin sheath formation.
• Prompt diagnosis and management of VAD complications can prevent severe patient outcomes like extravasation.
• Understanding the link between fibrin sheaths and extravasation informs clinical practice and device management protocols.