TY - JOUR
T1 - Location and structure of fibrous sheath formed after placing a tunneled hemodialysis catheter in a large pig model
AU - Florescu, Marius C.
AU - Runge, Joseph
AU - Flora, Maurino
AU - Nio, George
AU - Lof, John
AU - Stolze, Elizabeth
AU - Fry, Gretchen
AU - Radio, Stanley J.
AU - Foster, Kirk W.
PY - 2018/9/1
Y1 - 2018/9/1
N2 - Background and objectives: We evaluated the location and structure of the fibrous sheath formed after the placement of tunneled, cuffed hemodialysis catheters in large animals, 70 kg pigs. We focused on describing the location of the fibrous sheath in relation to the catheter. Its location explains the fibrous sheath’s ability to cause catheter dysfunction by covering the catheter exit ports located at the catheter’s tip. Design: We used three animals. Each animal had a tunneled, cuffed, 15-French diameter hemodialysis catheter placed in the external jugular vein, with the tip at the junction of the superior vena cava and the right atrium. Two animals were sacrificed at 5 weeks and one animal at 17 weeks after catheter placement. The catheter and surrounding tissues were removed in one block. The fibrous sheath was dissected and longitudinally cut along the catheter to evaluate its extension in relation to the catheter. Relevant portions of the fibrous sheath were sent for pathology examination. Results: The fibrous sheath covered the catheter in its entire length and circumference. It started at the entry site and continued without any interruption along the entire length of the catheter, including the tip. Its average thickness is 1 mm and has an inner cellular/inflammatory layer comprising lymphocytes, plasma cells, neutrophils, macrophages, multinucleated giant cells, and spindled cells and an outer layer comprising a mixture of collagen and fibroblasts. Conclusion: Our model showed that the fibrous sheath forms around all catheters and covers them in their entire length and circumference without any gaps.
AB - Background and objectives: We evaluated the location and structure of the fibrous sheath formed after the placement of tunneled, cuffed hemodialysis catheters in large animals, 70 kg pigs. We focused on describing the location of the fibrous sheath in relation to the catheter. Its location explains the fibrous sheath’s ability to cause catheter dysfunction by covering the catheter exit ports located at the catheter’s tip. Design: We used three animals. Each animal had a tunneled, cuffed, 15-French diameter hemodialysis catheter placed in the external jugular vein, with the tip at the junction of the superior vena cava and the right atrium. Two animals were sacrificed at 5 weeks and one animal at 17 weeks after catheter placement. The catheter and surrounding tissues were removed in one block. The fibrous sheath was dissected and longitudinally cut along the catheter to evaluate its extension in relation to the catheter. Relevant portions of the fibrous sheath were sent for pathology examination. Results: The fibrous sheath covered the catheter in its entire length and circumference. It started at the entry site and continued without any interruption along the entire length of the catheter, including the tip. Its average thickness is 1 mm and has an inner cellular/inflammatory layer comprising lymphocytes, plasma cells, neutrophils, macrophages, multinucleated giant cells, and spindled cells and an outer layer comprising a mixture of collagen and fibroblasts. Conclusion: Our model showed that the fibrous sheath forms around all catheters and covers them in their entire length and circumference without any gaps.
KW - Hemodialysis catheter
KW - animal model
KW - fibrous sheath
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U2 - 10.1177/1129729818760978
DO - 10.1177/1129729818760978
M3 - Article
C2 - 29587560
AN - SCOPUS:85052561256
VL - 19
SP - 484
EP - 491
JO - Journal of Vascular Access
JF - Journal of Vascular Access
SN - 1129-7298
IS - 5
ER -