Fluoroscopy of central venous catheters

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Author: Mikael Häggström [notes 1]

File:Central venous catheter with a fibrin sheath.jpg
The fibrin sheath is indirectly seen in these images before and after radiocontrast infusion, as the radiocontrast collects around the catheter.

Fibrin sheaths of central venous catheters can be suspected when it is possible to infuse into it but not to aspirate.

Technique

Fibrin sheaths are usually detected by fluoroscopic catheter contrast angiography.[1] Non-ionic contrast with a high iodine concentration (for example 300 mg/ml) is injected by hand using a 10 ml or 20 ml[1] syringe. A precontrast view is followed by a series of images at a small field-of-view.[1] It can be done at 2-4 images per second,[1] but also up to 15 images per second and a short exposure time of 3-4 seconds.

Report

File:Mediastinal structures on chest X-ray, annotated.jpg
Locations of the central veins.

The report should include:

  • Position of the catheter tip in relation to the central veins
  • Presence or absence of fibrin sheath

References

  1. ↑ 1.0 1.1 1.2 1.3 Knutstad, K.; Hager, B.; Hauser, M. (2016). "Radiologic diagnosis and management of complications related to central venous access ". Acta Radiologica 44 (5): 508–516. doi:10.1080/j.1600-0455.2003.00115.x. ISSN 0284-1851. 


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