Central Catheter Fibrin Sleeve—Heparin Effect

Abstract

Intravascular abnormalities were well documented with central venous catheters. A prospective randomized study was undertaken to assess the actual incidence of such abnormalities with a silicone catheter and the effect of heparin in small doses on the formation of such abnormalities. Silicone catheters placed via the subclavian route were inserted for intravenous nutritional support. A standard solution of 5% amino acid and 20 to 25% dextrose was utilized and patients were randomized to receive 1000 units of heparin per liter or no heparin. Catheter venograms were performed at the conclusion of therapy. Thirty-four patients were completed with 17 patients in the heparin group and 17 in the control group. There was obvious fibrin sleeve formation in nine of 17 (53%) in the heparin group and 11 of 17 (65%) in the control group. The duration of catheter stay correlates with the incidence of intravascular fibrin sleeve formation. Intravascular reactions to central catheters occur, regardless of catheter compositions, and result in fibrinous material adherent to the venous wall. Low doses of heparin do not eradicate this problem. Although fibrin sleeve formation was a significant problem, there was no incidence of central venous thrombosis when silicone catheters were utilized.