Techniques in vascular and interventional radiology
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Tech Vasc Interv Radiol · Jun 2002
ReviewFibrin sheaths and central venous catheter occlusions: diagnosis and management.
Central venous catheter malfunction diagnosis and treatment is a growing component of the field of interventional radiology. A thorough understanding of the causes of catheter malfunction and the technical skills needed to treat these problems are necessities to appropriate management. ⋯ Differentiating a sheath from thrombus is imperative to appropriate therapy. The purpose of this article is to provide an understanding of the causes of fibrin sheaths and how to treat them.
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Catheter-induced venous thrombosis remains a significant problem in current clinical practice. A high level of biocompatibility of the materials used to manufacture the existing venous access devices has not eliminated catheter-induced venous thrombosis. ⋯ The focus of this article is on discussion of the various factors that influence formation of catheter-induced venous thrombosis. Also discussed is the management of this clinical problem, and a useful algorithm is outlined.
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Venous access is commonly thought of as the bread and butter of interventional radiologic procedures. However, in those patients who have undergone multiple previous central venous catheter placements, venous access can be a technical challenge for even the most seasoned interventional radiologist. Conventional access sites include the internal jugular veins (IJV) and subclavian veins (SCV). ⋯ Only after surgical hemodialysis access is no longer an option in the upper extremity should cannulation of the SCV be entertained. Once these usual access sites are no longer available, it may necessary to use an unconventional access method, including catheterization of the common femoral vein, catheterization of enlarged collateral vessels, recanalization of occluded veins, translumbar inferior vena cava (IVC) catheter placement, and transhepatic catheter placement. This chapter serves as a review of these techniques.