Composition and formation of the sleeve enveloping a central venous catheter

Abstract

The sleeve around a central venous catheter is not a fibrin sleeve, but a stable cellular-collagen tissue covered by endothelium. It is mainly formed by smooth muscle cells migrating from the injured vein wall into the early pericatheter thrombus.

Catheter-Related Sheaths (CRS): Pathophysiology and Treatment Strategies

“…The first variety is a mesh-like thrombus that bridges the vein wall and catheter. This is thought to evolve into the mixed cellular and collagen catheter-related sleeve described by these authors in an earlier report [12]. A second, nonorganized form of thrombus has been termed "sleeve-related thrombus" and is found on the distal aspects of the indwelling catheter itself.…”

“…More recently, the work of Xiang et al more accurately described the CRS as cellular-collagen tissue covered by an endothelial layer. Fibrin was described a component of an early physiologic response to the catheter that consists of pericatheter thrombus, but the CRS itself is not composed of fibrin [12]. Subsequent papers by these authors and others reinforced the concept of CRSs representing a spectrum of thrombosis and thrombus organization [13][14][15][16].…”

“…An early description of this coating appeared in the French literature in 1964 [11]. Since that time, the covering has been referred to as a fibrin sleeve [2,3], a sleeve thrombus [4], a sleeve [12], and-the most recognized phrase-a fibrin sheath [5]. The reported frequency of this observation ranges from 42% to 100% [2][3][4][5].…”

“…In a second, larger study [12], again performed in a rat model, catheters were placed via the jugular vein in 123 animals. Histologic changes were studied at catheter indwelling times that ranged from 1 day to 6 months.…”

Comparative Study of Histological Alterations in Intravascular Catheter Region with and without the Use of Local Corticosteroid

“…Several complications have been described, not only in the moment of catheter insertion, but also during its permanence in the vein and its removal [4]. Lesions such as venous laceration, dissection of the venous wall and accidental arterial punction, pneumothorax, hematoma, and even death might occur at the moment of the catheter insertion [5] [6].…”