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Central venous access device-related sheaths: a predictor of infective and thrombotic incidence?

24 October 2019
Volume 28 · Issue 19


Central vascular access device (CVAD)-related sheaths, sometimes described as ‘fibrin sheaths’, may result in minor or significant sequelae, from persistent withdrawal occlusion (PWO) to infective sheaths associated with increased morbidity and mortality. The authors studied 179 patients who underwent isotope scans, where isotope was infused via the CVAD. Isotope was found to bind to the sheaths around the catheters of some patients. The amount of uptake was taken to be an extent to which a sheath had developed around the CVAD. The degree of uptake of isotope was categorised into three groups: low uptake, moderate uptake and high uptake. Patients were then followed up from the date the CVAD was inserted to 12 months after the date of the isotope scan, until the device was removed or to the date the patient died, to identify incidence of infection, thrombosis and PWO. PWO incidence in all levels of uptake was around 5–7%. Bloodstream infection (BSI) incidence for low uptake was 7% (9/130), moderate uptake 10% (3/30) and for patients with significant uptake 16% (3/19). Thrombosis for no uptake was less than 1% (1/130), moderate uptake 7% (2/30), and significant uptake had no incidence of thrombosis. Total complications: no uptake 15%, moderate uptake 23% and significant uptake 21%. This single-centre study showed that patients with isotope-highlighted sheaths experienced higher incidence of infective, thrombotic and total complications.

Central venous access device (CVAD)-related sheaths are a phenomenon that may lead to minor functional problems of CVADs or significant sequelae for patients, such as the development of extravasation (Mayo, 1998; Kumwenda et al, 2018a) and are associated with venous occlusion (Krausz et al, 2014). CVAD functionality may be adversely affected—there may be failure to withdraw blood (persistent withdrawal occlusion), or infusion rates can be reduced (Kuter, 2004). Both of these lead to delayed or missed intravenous therapy. Protocols within the authors’ institution for persistent withdrawal occlusion related to CVAD sheaths may include chest X-ray, administration of thrombolytic agents and saline infusions to ensure the device is safe to use. This process has a negative impact on the patient experience and clinical and financial resources.

The incidence of CVAD sheaths has been reported to be 78-100% (Kuter, 2004). Seifert et al (1997) explained that virtually all foreign-body material soon becomes coated with glycoproteins containing fibrinogen, fibronectin, collagen and other proteins.

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