Pediatric Radiology

, Volume 49, Issue 1, pp 141–145 | Cite as

A novel technique for removing a fibrin sheath from a mediport catheter in the pediatric population

  • Avinash N. MedsingeEmail author
  • Fernando A. Escobar
  • Sabri Yilmaz
  • James K. Park
  • John J. Crowley
Technical Innovation


Mediport (also known as port, portacath or Infusaport) is a commonly placed central venous access in pediatric patients. Fibrin sheath formation around the central venous catheter is a common biological response leading to port malfunction in the form of inability to aspirate but preserved capacity for infusion of fluids. If fibrinolytic therapy fails, percutaneous fibrin sheath stripping via transfemoral route or replacement with a new mediport are routine/conventional treatments for a fibrin sheath. We describe a novel technique for removing a fibrin sheath by exteriorizing the catheter through the neck entry site, stripping the fibrin sheath from the catheter manually under sterile conditions and replacing the catheter via a peel-away sheath introduced through the same skin incision as an alternative to complete port replacement or attempted catheter stripping.


Central venous catheter Children Fibrin sheath Interventional radiology Mediport catheter 


Compliance with ethical standards

Conflicts of interest



  1. 1.
    Barnacle A, Arthurs OJ, Roebuck D, Hiorns MP (2008) Malfunctioning central venous catheters in children: a diagnostic approach. Pediatr Radiol 38:363–378CrossRefGoogle Scholar
  2. 2.
    Crain MR, Mewissen MW, Ostrowski GJ et al (1996) Fibrin sleeve stripping for salvage of failing hemodialysis catheters: technique and initial results. Radiology 198:41–44CrossRefGoogle Scholar
  3. 3.
    Funaki B (2002) Central venous access: a primer for the diagnostic radiologist. AJR Am J Roentgenol 179:309–318CrossRefGoogle Scholar
  4. 4.
    Crain MR, Horton MG, Mewissen MW (1998) Fibrin sheaths complicating central venous catheters. AJR Am J Roentgenol 171:341–346CrossRefGoogle Scholar
  5. 5.
    Tschirhart JM, Rao MK (1988) Mechanism and management of persistent withdrawal occlusion. Am Surg 54:326–328Google Scholar
  6. 6.
    Kidney DD, Nguyen DT, Deutsch LS (1998) Radiologic evaluation and management of malfunctioning long-term central vein catheters. AJR Am J Roentgenol 171:1251–1257CrossRefGoogle Scholar
  7. 7.
    Crain M (1998) Management of fibrin sheaths I: percutaneous fibrin sheath stripping. Semin Dial 11:336–341Google Scholar
  8. 8.
    Gray RJ, Levitin A, Brown LC (2000) Percutaneous fibrin sheath stripping versus transcatheter urokinase infusion for malfunctioning well-positioned tunneled central venous dialysis catheters: a prospective, randomized trial. J Vasc Interv Radiol 11:1121–1129CrossRefGoogle Scholar
  9. 9.
    Merport M, Murphy TP, Egglin TK, Dubel GJ (2000) Fibrin sheath stripping versus catheter exchange for the treatment of failed tunneled hemodialysis catheters: randomized clinical trial. J Vasc Interv Radiol 11:1115–1120CrossRefGoogle Scholar

Copyright information

© Springer-Verlag GmbH Germany, part of Springer Nature 2018

Authors and Affiliations

  1. 1.Department of Radiology, Section of Interventional RadiologyUniversity of Pittsburgh Medical CenterPittsburghUSA
  2. 2.Department of Radiology, Section of Interventional RadiologyChildren’s Hospital of UPMCPittsburghUSA
  3. 3.Department of Radiology, Section of Interventional RadiologyChildren’s Hospital of PhiladelphiaPhiladelphiaUSA

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