Name of the Procedure:

• Mechanical removal of pericatheter obstructive material (such as fibrin sheath) from central venous device
• Also known as fibrin sheath stripping or catheter declotting

Summary

The procedure involves mechanically removing blockages, typically fibrin sheaths, from around a central venous catheter to restore its function. This is done using specialized tools via a separate vein while being guided by imaging techniques for accuracy.

Purpose

The primary purpose of this procedure is to clear obstructions from a central venous device, which is often used for long-term intravenous treatments like chemotherapy or dialysis. The goal is to ensure the catheter functions properly and to maintain effective blood flow through the device.

Indications

• Difficulty in drawing blood from or administering fluids through a central venous catheter
• Suspected or confirmed fibrin sheath formation around the catheter
• Catheter-related blood flow issues as detected by imaging or clinical symptoms

Preparation

• Patients may need to fast for a few hours before the procedure.
• Certain medications, especially blood thinners, may need to be adjusted.
• Pre-procedure imaging studies may be required to assess the catheter and surrounding vessels.

Procedure Description

1. The patient is positioned appropriately, and an alternate vein is accessed, typically under local anesthesia and sometimes with mild sedation.
2. Radiologic imaging (e.g., fluoroscopy) is used to guide the insertion of specialized tools to the site of the obstruction.
3. A sheath is introduced through the separate vein and advanced to the area surrounding the catheter.
4. Mechanical devices or tools are used to disrupt and remove the obstructive material.
5. The catheter's function is tested to confirm successful removal of the blockage.
6. All instruments are carefully removed, and the insertion site is bandaged.

Duration

The procedure typically takes about 1 to 2 hours.

Setting

It is usually performed in a hospital's interventional radiology suite or a specialized outpatient facility.

Personnel

• Interventional radiologist or vascular surgeon
• Radiologic technologists
• Nurses
• Anesthesiologist or nurse anesthetist (if sedation or anesthesia is used)

Risks and Complications

• Infection at the insertion site
• Bleeding or hematoma formation
• Vessel damage or perforation
• Dislodgement or damage to the catheter
• Rarely, pulmonary embolism if clot material is dislodged into the bloodstream

Benefits

• Restored functionality of the central venous catheter
• Avoidance of more invasive procedures, such as catheter replacement
• Immediate feedback on the success of the blockage removal

Recovery

• Patients may be monitored for a few hours post-procedure to ensure stability.
• Instructions will be provided for care of the insertion site, including keeping it clean and dry.
• Most patients can resume normal activities the following day, but strenuous activities should be avoided for a few days.
• Follow-up appointments may be necessary to evaluate the catheter's function.

Alternatives

• Thrombolytic therapy (using medication to dissolve the clot)
• Catheter exchange or replacement
• Surgical intervention
• Each alternative has its own risk profile and effectiveness, which should be discussed with the healthcare provider.

Patient Experience

Patients might feel slight pressure or discomfort during the vein access and tool insertion but should not experience significant pain due to local anesthesia and sedation. Post-procedure soreness at the insertion site is common but can be managed with over-the-counter pain medication. Most patients are able to return to normal activities within a day, with minor restrictions.