PICC is widely used in clinical practice due to its advantages of easy insertion, safety and cost-effectiveness, providing a reliable intravenous infusion pathway for patients undergoing chemotherapy, parenteral nutrition and home-based care. However, difficult catheter removal caused by fibrous sheath formation poses a significant challenge. This article reviews the current literature on the causes of fibrous sheath formation and nursing intervention strategies. Studies have shown that standardized PICC maintenance can reduce fibrous sheath formation. Low-dose urokinase and tPA-containing saline can improve recanalization rates to 95.3%. Salvia miltiorrhiza (Danshen) can inhibit sheath formation from the source. Patient education combined with monitoring can improve prognosis and reduce complications. These findings provide clinical nurses with practical guidelines to enhance PICC management safety and effectiveness, ultimately reducing patient harm and healthcare burdens.
References
[1]
Johansson, E., Hammarskjöld, F., Lundberg, D. and Arnlind, M.H. (2013) Advantages and Disadvantages of Peripherally Inserted Central Venous Catheters (PICC) Compared to Other Central Venous Lines: A Systematic Review of the Literature. Acta Oncologica, 52, 886-892. https://doi.org/10.3109/0284186x.2013.773072
[2]
Glauser, F., Kivrak, S. and Righini, M. (2018) Peripherally Inserted Central Catheters: Indications, Contraindications, Complications. Revue Médicale Suisse, 14, 2211-2213. https://doi.org/10.53738/revmed.2018.14.630.2211
[3]
Chen, P., Wu, Q.-Y. and Wu, G.-M. (2009) PICC Decannulation Difficult Cause Analysis and Countermeasures. Journal of Nursing, No. 19, 71-72.
[4]
Matusik, P.S., Łoboda, P., Krzanowska, K., Popiela, T.J., Heba, G. and Pawlik, W. (2020) Presence of Retained Calcified Fibrin Sheath after Central Venous Catheter Removal: A Systematic Literature Review. The Journal of Vascular Access, 23, 644-652. https://doi.org/10.1177/1129729820969328
[5]
Ni, N., Mojibian, H., Pollak, J. and Tal, M. (2010) Association between Disruption of Fibrin Sheaths Using Percutaneous Transluminal Angioplasty Balloons and Late Onset of Central Venous Stenosis. CardioVascular and Interventional Radiology, 34, 114-119. https://doi.org/10.1007/s00270-010-9875-1
[6]
Hoshal, V.L., Ause, R.G. and Hoskins, P.A. (1971) Fibrin Sleeve Formation on Indwelling Subclavian Central Venous Catheters. Archives of Surgery, 102, 353-358. https://doi.org/10.1001/archsurg.1971.01350040115023
[7]
Mogi, N., Nakagawa, M., Matsumae, H., Hattori, A., Shimohira, M. and Shibamoto, Y. (2018) Fibrin Sheath of a Peripherally Inserted Central Catheter Undepicted with Gray-Scale (Real-Time B-Mode) Ultrasonography: A Case Report. Radiology Case Reports, 13, 537-541. https://doi.org/10.1016/j.radcr.2018.02.016
[8]
Crain, M.R., Horton, M.G. and Mewissen, M.W. (1998) Fibrin Sheaths Complicating Central Venous Catheters. American Journal of Roentgenology, 171, 341-346. https://doi.org/10.2214/ajr.171.2.9694448
[9]
Roy, D., Wenxiang, Y. and Pande, S.D. (2020) A Calcified Central Venous Fibrin Sheath Mimicking a Fractured Catheter. Seminars in Dialysis, 33, 343-344. https://doi.org/10.1111/sdi.12887
[10]
Hughes, M.E. (2014) Reducing PICC Migrations and Improving Patient Outcomes. British Journal of Nursing, 23, S12-S18. https://doi.org/10.12968/bjon.2014.23.sup1.s12
[11]
Huo, J. (2021) Causes and Nursing Countermeasures of Common Complications after PICC in Cancer Chemotherapy Patients. Guide to Family Life, 37, 98-99.
[12]
Lyu, Q. (2017) Cause Analysis and Treatment Countermeasures of Complications after PICC Catheterization. Family Medicine. Medical and Drug Selection, No. 9, 193-194.
[13]
Yang, M.L., Zheng, H.W., Mo, X.Z., et al. (2017) Cause Analysis and Nursing of 32 Cases of Fibrin Sheath after PICC Catheterization. Journal of Mathematical Science and Medicine, 30, 941-942.
[14]
Li, J., Su, M. and Wang, X.F. (2013) Nursing Care of Patients with PICC Catheter Wrapped by Fibrin Sheath. 2013 Henan Province Intravenous Infusion Therapy Standardized Training Class and Academic Exchange Conference Proceedings, Zhengzhou, 16 May 2013, 41-42.
[15]
Tang, W.-S., Liao, H.-T., Liu, D., et al. (2017) Research Progress on Detection, Prevention and Treatment of Venous Indwelling Catheter Related Fibrin Sheath. Nursing Research, 31, 2575-2579.
[16]
Duan, Q.Q., Zhang, L.H., Zhang, W.Y., et al. (2012) Analysis of 28 Cases of Deep Venous Catheter Fibrin Sheath Observed by Color Doppler Ultrasound. China Blood Purification, 11, 198-201.
[17]
Ling, Q., Chen, Y., Li, B.F., et al. (2021) Predictive Effect of Ultrasound Combined with Laboratory Examination on Fibrin Sheath Formation in Cancer Patients at Infusion Port. Hebei Medicine, 43, 401-403+407.
[18]
Cao, L.-P. and Yan, W.-N. (2017) Research Progress on the Mechanism of Fibrin Sheath Formation and Recanalization Methods of PICC Catheter. Nursing Research, 31, 3912-3914.
[19]
Wang, F., Peng, W., Xi, H.L., et al. (2021) Effect of Heparin Combined with Urokinase on Central Venous Catheter Sealing in Hemodialysis Patients: A Meta-Analysis. Shanghai Nursing, 21, 16-21.
[20]
Chang, D., Mammadov, K., Hickethier, T., Borggrefe, J., Hellmich, M., Maintz, D., et al. (2017) Fibrin Sheaths in Central Venous Port Catheters: Treatment with Low-Dose, Single Injection of Urokinase on an Outpatient Basis. Therapeutics and Clinical Risk Management, 13, 111-115. https://doi.org/10.2147/tcrm.s125130
[21]
Ariyachaipanich, A., Oyejola, O., Melhem, A., Soundararajan, V., Lerma, E., Atassi, W., et al. (2010) Tissue Plasminogen Activator Infusion as a Treatment for Hemodialysis Catheter Dysfunction. Dialysis & Transplantation, 39, 97-99. https://doi.org/10.1002/dat.20417
[22]
Tang, W.S. (2018) Effect of Salvia miltiorrhiza on Fibrin Sheath Associated with Venous Indwelling Catheter. Guangxi Medical University. (In Chinese)
[23]
Duan, Q.-Q., Zhang, L.-H. and Wang, B.-X. (2011) Research Progress on Histopathological Characteristics and Pathogenesis of Fibrin Sheath in Central Venous Catheter. Chinese Journal of Blood Purification, 9, 503-506.
[24]
Shah, P., Khaleel, M., Thuptimdang, W., Sunwoo, J., Veluswamy, S., Chalacheva, P., et al. (2019) Mental Stress Causes Vasoconstriction in Subjects with Sickle Cell Disease and in Normal Controls. Haematologica, 105, 83-90. https://doi.org/10.3324/haematol.2018.211391
[25]
Fan, Z.Y., Yang, Y. and Chen, M.X. (2019) The Management of Difficult PICC Catheter Removal due to Fibrin Sheath. Nursing Research, 33, 4171-4172.
[26]
Sutherland, D.W., Blanks, Z.D., Zhang, X. and Charest, J.L. (2018) Relationship between Central Venous Catheter Protein Adsorption and Water Infused Surface Protection Mechanisms. Artificial Organs, 42, E369-E379. https://doi.org/10.1111/aor.13274
[27]
Zhang, M., Ma, Z.Z., Luan, S.L., et al. (2019) Observation on the Effect of Electronic Grip Device Combined with Clenching Fist Exercise on Improving Fibrin Sheath Related Catheter Dysfunction in PICC Cancer Patients. Journal of Advanced Nursing Education, 34, 2268-2270.
[28]
Chen, L.F., Li, J.Y., Yang, H.Y., et al. (2023) Training and Effectiveness of PICC Maintenance for Primary Nurses in Guangdong Province. Chinese Journal of Nursing Education, 20, 194-199.
[29]
Zhou, M.Y. (2023) Nursing and Reflection on a Child with Difficulty in Extubation Caused by Fibrin Sheath Formation after PICC Catheter Insertion. Contemporary Nurses (The Last Ten-Day Issue), 30, 159-161.
[30]
Long, Y.L. and Chen, L. (2017) Experience of 1 Case of PICC Catheter Fracture Caused by Difficulty in Extubation during Catheterization. Contemporary Nurses (The Last Ten-Day Issue), No. 1, 134-135.
