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NDT Advance Access originally published online on April 1, 2007
Nephrology Dialysis Transplantation 2007 22(6):1762-1765; doi:10.1093/ndt/gfm154
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© The Author [2007]. Published by Oxford University Press on behalf of ERA-EDTA. All rights reserved. For Permissions, please email: journals.permissions@oxfordjournals.org

Fibrin sheath removal from central venous catheters: an internal snare manoeuvre

Arra S. Reddy, Elvira V. Lang, Jennifer Cutts, Shaun Loh and Max P. Rosen

Department of Radiology, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA 02215, USA

Correspondence and offprint requests to: Shaun Loh, MD, MBA, Research Fellow, Beth Israel Deaconess Medical Center, One Deaconess Road, Room 327C, Boston, MA 02215, USA Email: sloh1{at}bidmc.harvard.edu



  Abstract

Background. Dysfunction of haemodialysis catheters is most commonly due to a narrowing of the catheter lumen and/or formation of a fibrin sheath around the catheter tip. Reported methods for restoring patency of the catheter lumen include passage of a J-tipped guide wire, passage of a biopsy brush through the catheter, or infusion of a thrombolytic agent into the catheter. While these methods are often effective, they suffer from several limitations. We present a minimally invasive technique to remove thrombi and debris from within the lumen of a partially thrombosed haemodialysis catheter while simultaneously stripping the fibrous sheath.

Methods. A 0.089 cm nitinol wire is bent to create a loop, which is then inserted via the catheters. Upon exiting the lumen of the catheters, the nitinol wire forces a snare open, which disrupts the fibrin sheath and catches intraluminal thrombi and debris. The technique requires no anaesthesia or recovery time.

Results. Initial clinical success in our series was achieved in all patients (7/7) as evidenced by restoration of target flow rates on subsequent haemodialysis. None of the patients experienced any complications as a result of the procedure. The catheter 2-, 4-, and 6-week primary success rates were 100% (8/8), 100% (8/8), and 100% (8/8) respectively with a mean duration of 17.1 weeks (range 8–40 weeks).

Conclusions. The internal snare technique is an effective, inexpensive and minimally invasive approach to restoring patency to failed central venous access catheters.

Keywords: central venous catheters; fibrin sheath stripping; fibrinolysis; internal snare; occluded haemodialysis catheters

Received for publication: 16.10.06
Accepted in revised form: 28. 2.07


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