Fibrin sheath formation and chemotherapy extravasation: a case report

Donna Jo Mayo

Fibrin sheath formation around venous access devices (VADS) frequently leads to persistent withdrawal occlusion (PWO). PWO is a common problem encountered with VADS. Although PWO is often easily managed with small doses of thrombolytic therapy (e.g., urokinase), it could result in a more serious complication, such as chemotherapy extravasation. Careful assessment of all VADs is important to identify complications such as fibrin sheath formation, which can potentially lead to extravasation. To rule out fibrin sheath formation, catheter dye studies need to be obtained when fibrinolytic therapy has failed to restore catheter function. The purpose of this paper is to illustrate a retrospective case report demonstrating drug extravasation caused by the development of fibrin sheath formation.

Key words: Extravasation, Fibrin sheath, Persistent withdrawal occlusion, Venous access device, Urokinase.

Presented as an invited lecture at the 9th International Symposium Supportive Care in Cancer, St. Gallen, Switzerland, 26 February-1 March 1997