The fibrous sheath of tunneled central venous catheters: A simple and reliable access for revision

Purpose Children may require the long-term use of a central venous catheter (CVC) for treatment. Multiple revisions may be required when these catheters malfunction. We herein reported our experience of utilizing the fibrous sheath in tunnelled CVCs for the revision. Methods A retrospective review was conducted from July 2008 to June 2018 on all children with the revision of tunnelled CVCs using the fibrous sheath. Results Sixteen children underwent 31 revisions of a tunnelled CVC (16 Broviac/Hickman catheters, 15 Permcath for haemodialysis). The age ranged from 6 months to 16 years old (mean 3.8 years old). The indications for CVC revision included blockage (n = 14), breakage (n = 9) and dislodgement (n = 6). The mean time interval between CVC insertion and revision was 10.1 months (range: 20 days to 39 months). The fibrous sheath could be used for re-insertion in 27 revisions (success rate: 87%). The failure was associated with the upsizing of the CVC (P = .003). In three of the four failed cases, a new CVC could be inserted by the cut-down technique through the same venous access site. The overall success rate of CVC revision using the same venous access was 97%. There was no 30-day postoperative infective complication. Conclusions The fibrous sheath of tunnelled CVCs is a reliable access for CVC re-insertion. This helps to preserve the same venous access site for repeated revision of CVCs. This is extremely important in those children who depend on long-term CVC usage.