A proper initial assessment of catheter occlusion is the key to successful management. The assessment screens are for both thrombotic and nonthrombotic causes (including mechanical occlusion). If mechanical occlusion is excluded, thrombotic occlusion is treated with alteplase. Nonthrombotic occlusions are treated according to their primary etiologies: lipid occlusion is treated with 70% ethanol, mineral precipitates are treated with 0.1-N hydrochloric acid (HCl), drug precipitates are treated according to their pH-acidic drugs can be cleared with 0.1-N HCl, basic medications can be cleared with sodium bicarbonate or 0.1-N sodium hydroxide (NaOH). Prevention of occlusion of central venous access devices is also critical. To date, no data conclusively show heparin flushes to be superior to saline flushes. No prophylactic regimen, including low-dose warfarin, low-molecular-weight heparin, or 1 unit heparin/mL of parenteral nutrition has been endorsed by any major medical, nursing, or pharmacy group due to lack of scientific evidence. The most encouraging information on decreasing occlusion rate comes from experience with positive-pressure devices that attach to the hub of most catheter lumens and prevent retrograde blood flow and, consequently, decrease the risk of thrombus formation in the catheter lumen.

Background Pediatric inflammatory bowel disease (IBD) — consisting of Crohn’s disease (CD) and ulcerative colitis (UC) — can result in significant morbidity requiring frequent healthcare utilization. While it is known that the overall financial impact of pediatric IBD is significant, the direct out-of-pocket (OOP) cost burden on the parents of children with IBD has not been explored. We hypothesized that affected children with a more relapsing disease course and families in lower income strata, ineligible for need-based assistance programs, disparately absorb ongoing financial stress. Methods We completed a cross-sectional analysis among parents of children with IBD residing in California using an online HIPAA-secure Qualtrics survey. Multicenter recruitment occurred between December 4, 2013 and September 18, 2014 at the point-of-care from site investigators, informational flyers distributed at regional CCFA conferences, and social media campaigns equally-targeting Northern, Central, and Southern California. IBD-, patient-, and family-specific information were collected from the parents of pediatric IBD patients <18 years of age at time of study, carry a confirmed diagnosis of CD or UC, reside in and receive pediatric gastroenterology care in California, and do not have other chronic diseases requiring on-going medical care. Results We collected 150 unique surveys from parents of children with IBD (67 CD; 83 UC). The median patient age was 14 years for both CD and UC, with an overall 3.7 years (SD 2.8 years) difference between survey completion and time of IBD diagnosis. Annually, 63.6%, 28.6%, and 5.3% of families had an OOP cost burden >$500, >$1000, and >5000, respectively. Approximately one-third (36.0%) of patients had emergency department (ED) visits over the past year, with 59.2% of these patients spending >$500 on ED copays, including 11.1% who spent >$5,000. While 43.3% contributed <$500 on procedure and test costs, 20.0% spent >$2,000 in the past year. Families with household income between $50k–100k had a statistically significant probability (80.6%) of higher annual OOP costs than families with lower income <$50k (20.0%; P<0.0001) or higher income >$100k (64.6%; P<0.05). Multivariate analysis revealed that clinical variables associated with uncontrolled IBD states correlated to higher OOP cost burden. Annual OOP costs were more likely to be >$500 among patients who had increased spending on procedures and tests (OR 5.63, 95% CI 2.73 – 11.63), prednisone course required over the past year (OR 3.19, 95% CI 1.02 – 9.92), at least one ED visit for IBD symptoms (OR 2.84, 95% CI 1.33 – 6.06), at least 4 or more outpatient primary medical doctor (PMD) visits for IBD symptoms (OR 2.82, 95% CI 1.40 – 5.68), and history of 4 or more lifetime hospitalizations for acute IBD care (OR 2.60, 95% CI 1.13 – 5.96). Conclusions Previously undocumented, a high proportion of pediatric IBD families incur substantial OOP cost burden. Patients who are frequently in relapsing and uncontrolled IBD states require more a...