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How to identify and reduce the risk of catheter-related thrombosis

Catheter-related thrombosis is reported as one of the most common complications following central venous access insertion.1  

Although it has been widely studied and discussed, there still exists some confusion around catheter technologies, insertion techniques and management bundles.1,2 

Dr Fulvio Pinelli, Director of the Vascular Access Centre at the Careggi University Hospital in Florence, Italy, presented on this topic at the BD Multidisciplinary Advanced Course on Vascular Access (MACOVA) 2022.2 

Catheter-related thrombosis, occlusion or fibroblastic sleeve?

“When we talk about thrombosis,” said Dr Pinelli. “We have to be clear on the definition.”2 

In fact, he noted that much of the published literature still appears confused on the differences between catheter-related thrombosis, occlusion and fibroblastic sleeves.2 

Dr Pinelli characterised occlusion as a condition of the internal catheter lumen, determined by an intraluminal clot.2 

In the last 50 years, fibroblastic sleeves have been given various names, including fibrin sleeves, fibrin sheaths, catheter sleeves or catheter-related sleeve.2 While the terms “sleeve” and “sheath” may be correct, said Dr Pinelli, “fibrin” certainly is not, since a fibroblastic sleeve is composed of connective tissue with its main non-cellular component being collagen, not fibrin.2 As a foreign body reaction, fibroblastic sleeves are harmless and typically require no treatment.2 

Dr Pinelli presented evidence of the three main factors that determine thrombosis and how it differs from other conditions, a system coined by Berlin Pathologist Rudolf Virchow known as “Virchow’s Triade:”2 

  1. Endothelial damage: Catheter insertion 
  2. Blood stasis: Presence of catheter itself, infusion fluids, immobilisation 
  3. Hypercoagulability: Sepsis, malignancies, inflammation, thrombophilia 

“We can’t do much on hypercoagulability, it’s a condition of the patient,” said Dr Pinelli. “But we can do something, even if not everything, for endothelial damage and blood stasis.”2 

More on this topic: Thrombosis

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References

  1. Pinell F, Balsorano P, Mura B, Pittiruti M. Reconsidering the GAVeCeLT Consensus on catheter-related thrombosis, 13 years later. J Vasc Access. 2021 Jul;22(4):501-508. DOI: 10.1177/1129729820947594.   
  2. Pinelli F. Thrombosis—causative factors and preventative measures. Lecture presented at: The 2022 BD Multidisciplinary Advanced Course on Vascular Access (MACOVA); 9 June 2022; Berlin, Germany.   

The presentation is made on behalf of BD and contains the opinions, techniques and practices by Dr Fulvio Pinelli.  The opinions and techniques presented herein are for informational purposes only.  

This list of references to third-party peer-reviewed material and the sites they are hosted on are provided for your reference and convenience only, and do not imply any review or endorsement of the material or any association with their operators.  The Third-Party References (and the Web sites to which they link) may contain information that is inaccurate, incomplete, or outdated. Your access and use of the Third Party Sites (and any Web sites to which they link) is solely at your own risk. 

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