Abstract No. 190 Fibrin sheath stripping of pediatric chest port catheters

Abstract

This retrospective analysis describes the role, technique, and outcomes of fibrin sheath stripping of pediatric chest port catheters recently performed at our institution. This study was a retrospective case series of pediatric fibrin sheath stripping at the University of Iowa Hospitals and Clinics with approval from our IRB. Patients with chest ports and clinical and/or imaging diagnosis of fibrin sheath between January 2019 and June 2020 were included in the study after failed fibrinolytic instillation necessitating fibrin sheath stripping. A total of nine patients ranging from 3 years 5 months to 13 years 9 months in age at the time of the procedure were included. Fibrin sheath stripping was performed on an outpatient basis after informed consent was obtained by the parent/durable power of attorney. Patients were induced under general anesthesia and the chest and groin were prepped and draped. A venogram was performed through the chest port to identify the presence of fibrin sheath, and port aspiration was attempted. The right groin was accessed under ultrasound guidance using a micropuncture kit and the Seldinger technique, and a 4F sheath was placed. A 5 to 10mm × 120cm Gooseneck snare was used to perform fibrin sheath stripping under direct fluoroscopic visualization. Once aspiration was performed and normal flow was demonstrated on repeat venogram the procedure was terminated. Our primary endpoints were technical success rate and added days of catheter patency. Our secondary endpoints were procedural complication rates, total fluoroscopic time, and total fluoroscopic dose. Follow-up was performed from the time of the initial procedure until the time of submission of this abstract. All procedures attempted were technically successful. There was an average of 348 days of added catheter patency. One patient had early recurrence of fibrin sheath at 186 days post procedure which was treated with repeated stripping, otherwise no procedural complications were observed. Total fluoroscopic time averaged 20 mins and total fluoroscopic dose averaged 33 mGy. Our total days of added catheter patency averaged 348 days compared to a median of 280 days of median chest port. One case of early recurrence of fibrin sheath was potentially due to incomplete stripping. Our results are biased by short follow-up interval due to multiple recently performed procedures; however, this should only continue to add to added days of catheter patency.