3:18 PM Abstract No. 357 Fibrin sheath removal from port-a-cath by exteriorization of the catheter by snaring through a shortened vascular sheath: a novel technique

Abstract

Port-a-caths are commonly placed central venous access devices in children. Fibrin sheath formation is a common complication leading to port malfunction. Unlike other tunneled central line, port-a-caths cannot easily be exchanged over a wire. Treatment of fibrin sheath formation include fibrinolytic therapy, fibrin sheath stripping via transfemoral route or replacement. We describe an alternative minimally invasive technique of fibrin sheath removal. This novel technique was performed on 4 patients with port-a-cath who had failed fibrinolytic therapy and presence of fibrin sheath confirmed on contrast injection. The port was accessed under aseptic precautions. Ultrasound-guided right internal jugular vein access was performed just cranial to previous catheter insertion site and shortened vascular sheath which was one and half times larger French size relative to the size of the port catheter, was inserted. Catheter tip was successfully snared under fluoroscopic guidance using a 30 mm Goose Neck snare. Catheter was then exteriorized through the sheath. Catheter was then cleaned with a wet Telfa gauze to clear any fibrin sheath. A 0.018” Nitrex wire was also passed through the catheter to clear intra catheter clot or debris. Catheter was reinserted back through the vascular sheath into right atrium with the help of snare. Port-a-cath function was restored in all 4 patients with satisfactory flushing and aspiration. Contrast venogram was performed to confirm function and no residual fibrin sheath was demonstrated. No complications were encountered. In conclusion, fibrin sheath removal by exteriorization of port catheter by snaring through shortened vascular sheath is an attractive alternative which is minimally invasive and highly effective, compared to traditional stripping or replacement with new port.