Fibrin sheath on a tunnelled haemodialysis catheter

Robert K. Peel and John H. Turney

Renal Unit, The General Infirmary at Leeds, Leeds, UK

Keywords: fibrin sheath; Tesio; tunnelled haemodialysis catheter

A 65-year-old patient with a renal allograft underwent cystectomy and creation of ileal conduit for bladder cancer, which resulted in the failure of renal transplant. The patient had no mature native vascular access and was dialysed on a temporary and later a dual lumen tunnelled haemodialysis line (Tesio). Flows in the Tesio catheter were poor and the lines were removed because of the maturation of a Cimino fistula, making it redundant.

Figures 1Go and 2Go show the two limbs of the tunnelled haemodialysis catheter, and clearly visible on the red dialysis line is a large fibrin sheath covering the ports on the line and responsible for impaired flows.



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Fig. 1.  Photograph of the removed Tesio line showing a clean venous line blue lower line, and a red upper line with an extensive fibrin sheath attached.

 


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Fig. 2.  The lower venous limb of the Tesio catheter has clearly patent apertures, compared with the upper arterial line where both the small side apertures and the larger distal apertures are disrupted by thrombus.

 
The Achilles heel of haemodialysis is access. Where native vein or PTFE fistulas are immature or not feasible, central venous catheters are required. Adequate flows are needed to achieve effective dialysis dose. Together with infection of dialysis lines the formation of fibrin sheaths, which significantly impair flow, is a common problem.

The fibrin may be disrupted by infusion through or instillation into the line of thrombolytic drugs such as urokinase or rTPA, or by physically stripping the line by the use of snares introduced via a second venepuncture site and passed over the line [1].

Conflict of interest statement. None declared.

Notes

Correspondence and offprint requests to: Dr R. K. Peel, Renal Unit, The General Infirmary at Leeds, Great George Street, Leeds LS1 3EX, UK. Email: robpeel{at}doctors.org.uk Back

Reference

  1. Gray RJ, Levitin A, Buck D et al. Percutaneous fibrin sheath stripping versus transcatheter urokinase infusion for malfunctioning well-positioned tunnelled central venous dialysis catheters: a prospective randomised trial. J Vasc Interv Radiol 2000; 11:1121–1129[Abstract/Free Full Text]




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