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[[File:PAC met Gripper erin.JPG|thumb|160px|Port An implanted port with needle assembly inserted.]]Fibrin sheaths of ports can be suspected when it is possible to infuse into it but not to aspirate.
==Suspected fibrin sheath==A fibrin sheath of central venous catheter (including PICC-lines and implanted ports) can be suspected when it is possible to infuse into it but not to aspirate. ===Choice of modality===
Fibrin sheaths are usually detected by fluoroscopic catheter contrast angiography.<ref name="KnutstadHager2016">{{cite journal|last1=Knutstad|first1=K.|last2=Hager|first2=B.|last3=Hauser|first3=M.|title=Radiologic diagnosis and management of complications related to central venous access|journal=Acta Radiologica|volume=44|issue=5|year=2016|pages=508–516|issn=0284-1851|doi=10.1080/j.1600-0455.2003.00115.x}}</ref>
Ability to aspirate from the catheter can optionally be tested.
*Contrast should be non-ionic,<ref name="KnutstadHager2016"/> with an iodine concentration of at least 270 mg/ml.<ref name=Helsingborg/>
*Syringe can be for example 10 ml or 20 ml, for injection by hand.<ref name="KnutstadHager2016"/> For pumpsin ports, the pressure should not exceed >40psi (275kPa or 2,75bar).<ref name=Helsingborg/>*The For ports, the needle should be at least 20G (0.9mm), and needs to be designed for port use (to avoid fragmentation of the port membrane).<ref name=Helsingborg>{{cite web|url=http://www.rontgen.com/metod/lungor-cvkport-a-cath|title=Porta-a-cath control|website=Röntgen Metodbok, Radiology Department of Helsingborg|accessdate=2018-07-25}}</ref> It should be connected by luer taper.<ref name=Helsingborg/>
*The system needs to be closed to air at all times.<ref name=Helsingborg/>
==Image taking==
Precontrast imaging
*Including For ports, it should include a lateral projection of the port to confirm that the needle is in proper place before contrast infusion.<ref name=Helsingborg/>
Contrast imaging
*A small field-of-view.<ref name="KnutstadHager2016"/>
*Posteroanterior projection, or slightly oblique to avoid superimposing the spine.<ref name=Helsingborg/>
*First For ports, a first image is taken when the contrast filling of fills the port chamber and the catheter to exclude malfunction.<ref name=Helsingborg/>
*Imaging of the outflow from the catheter is imaged at 10-15<ref name="Frequency" group="notes">A frequency of 2-4 images per second has also been suggested (Knutstad, 2016), which confers a lower radiation dose but makes it more difficult to determine the dynamic flow of contrast.</ref> images per second.<ref name=Helsingborg/>
