Fibrin sheath and port occlusion
Since a few of us here have had port problems, thought I would add a little more information on the causes of clogging.
I posted and then the server problems here "ate" a few threads including mine on the port problem, which had some good replies and perhaps some I did not see.
My catheter line had a small loop in it a little ways past my port and this must have happened at the initial placement according to my experts at the cancer center. This was discovered during a DYE STUDY done under a Flouroscope, which is also what they use to follow the insertion of the catheter in a new placement. The loop was not obstructing. The problem was a fibrin sheath that had thickened where the catheter enters the vein.
Here is some info on how this happens. Another site I read said that fibrin buildup starts only a few minutes after the catheter is placed in the vein. This is from the platelets and clotting factors that come rushing to the incision site.
Central Line Complications
Partial Catheter Occlusion
Causes:
* Common occurrence in long-term catheters secondary to long dwell-time of these catheters.
* Encasement of the catheter by a fibrin sheath. The fibrin sheath may also become seeded with microorganisms which may disseminate into the bloodstream.
*Residue of blood products deposited within some central venous access devices each time blood is aspirated or infused.
*Small clots adhering to the catheter tip.
*Drug precipitation adhering to the wall of the catheter.
Signs and Symptoms:
* Withdrawl occlusion - the inability to withdraw blood from the catheter but are able to infuse fluid. The fibrin sheath or blood/drug precipitates acts as a flap over the tip of the catheter when blood is withdrawn but opens when fluid is injected.
Interventions:
* Do not infuse any product through a central line that does not have a blood return.
*Notify the physician.
* May need chest x-ray for verification of tip placement.
Prevention:
* Strict adherence to the flushing protocol before and after drug infused and after blood drawn.
*With persistent withdrawl occlusion, may need to follow the fibrinolytic agent protocol to lyse the fibrin sheath or cleanse the catheter of residual blood products.
http://www.rncentral.com
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Live in the moment.
MY STORY SO FAR ~~~~
Found suspicious lump 9/2000
Lumpectomy, then node dissection and port placement
Stage IIB, 8 pos nodes of 18, Grade 3, ER & PR -
Adriamycin 12 weekly, taxotere 4 rounds
36 rads - very little burning
3 mos after rads liver full of tumors, Stage IV Jan 2002, one spot on sternum
Weekly Taxol, Navelbine, Herceptin for 27 rounds to NED!
2003 & 2004 no active disease - 3 weekly Herceptin + Zometa
Jan 2005 two mets to brain - Gamma Knife on Jan 18
All clear until treated cerebellum spot showing activity on Jan 2006 brain MRI & brain PET
Brain surgery on Feb 9, 2006 - no cancer, 100% radiation necrosis - tumor was still dying
Continue as NED while on Herceptin & quarterly Zometa
Fall-2006 - off Zometa - watching one small brain spot (scar?)
2007 - spot/scar in brain stable - finished anticoagulation therapy for clot along my port-a-catheter - 3 angioplasties to unblock vena cava
2008 - Brain and body still NED! Port removed and scans in Dec.
Dec 2008 - stop Herceptin - Vaccine Trial at U of W begun in Oct. of 2011
STILL NED everywhere in Feb 2014 - on wing & prayer
7/14 - Started twice yearly Zometa for my bones
Jan. 2015 checkup still shows NED
2015 Neuropathy in feet - otherwise all OK - still NED.
Same news for 2016 and all of 2017.
Nov of 2017 - had small skin cancer removed from my face. Will have Zometa end of Jan. 2018.
Last edited by StephN; 08-12-2006 at 12:33 PM..
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