Alteplase for the Treatment of Catheter Occlusion in Pediatric Patients

Anderson, Debra M; Pesaturo, Kimberly A.; Casavant, Jonathan; Ramsey, E. Zachary

doi:10.1345/aph.1q483

Cited by 20 publications

(12 citation statements)

References 16 publications

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“…A literature review focusing on pediatric patients with CVCs and the use of TPA revealed that 50–90% of catheters were cleared of thrombosis when TPA was instilled, with improved efficacy when doses where higher and dwell times were longer (53). Unfractionated heparin has also been used to maintain and improve catheter patency.…”

Section: Resultsmentioning

confidence: 99%

The Impact of Central Venous Catheters on Pediatric Venous Thromboembolism

2017

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The use of central venous catheters (CVCs) in children is escalating, which is likely linked to the increased incidence of pediatric venous thromboembolism (VTE). In order to better understand the specific risk factors associated with CVC-VTE in children, as well as available prevention methods, a literature review was performed. The overall incidence of CVC-VTE was found to range from 0 to 74%, depending on the patient population, CVC type, imaging modality, and study design. Throughout the available literature, there was not a consistent determination regarding whether a particular type of central line (tunneled vs. non-tunneled vs. peripherally inserted vs. implanted), catheter material, insertion technique, or insertion location lead to an increased VTE risk. The patient populations who were found to be most at risk for CVC-VTE were those with cancer, congenital heart disease, gastrointestinal failure, systemic infection, intensive care unit admission, or involved in a trauma. Both mechanical and pharmacological prophylactic techniques have been shown to be successful in preventing VTE in adult patients, but studies in children have yet to be performed or are underpowered. In order to better determine true CVC-VTE risk factors and best preventative techniques, an increase in large, prospective pediatric trials needs to be performed.

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Section: Resultsmentioning

confidence: 99%

The Impact of Central Venous Catheters on Pediatric Venous Thromboembolism

2017

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“…When reviewing the secondary outcomes, we found no significant differences between cohorts in number of complete occlusions. This was an unexpected result because Anderson et al (2013) in their review reported that shorter times between identification of an occlusion and treatment improved CVAD patency outcomes. In the present study, the failure to find a significant difference between cohorts in number of complete occlusions may be attributed to deviations to the nurseled protocol.…”

Section: Discussionmentioning

confidence: 96%

“…To our knowledge, no similar studies have been conducted to evaluate the effect of a nurse-led protocol on time to treatment of partially occluded CVADs in either adult or pediatric populations. The majority of pediatric studies (reviews and original research) focused on dose and dwell times (Anderson et al, 2013;Giordano et al, 2015;Peng et al, 2011;Soylu et al, 2010), number of instillations (Anderson et al, 2013;Peng et al, 2011), restoration of patency (Anderson et al, 2013;Blaney et al, 2006;Peng et al, 2011), and complications. (Blaney et al, 2006;Soylu et al, 2010;Ullman et al, 2015).…”

Section: Discussionmentioning

confidence: 99%

“…In a review of 10 studies evaluating the thrombolytic alteplase in restoring CVAD patency among children from birth to 18 years, overall salvage success rate ranged from 50% to 90% (Anderson et al, 2013). A multicenter, single-arm study demonstrated that a maximum of two doses of alteplase was safe for children aged 2 to 16 years (i.e., did not result in intracranial hemorrhage) and restored CVAD patency in 82.9% of the cases (Blaney et al, 2006).…”

Section: Introductionmentioning

confidence: 99%

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Effect of a Nurse-Led Protocol on Time to Treatment of Partial Occlusions in Central Venous Access Devices in Pediatric Oncology

Hunter

Cunningham

Yuen

et al. 2020

J Pediatr Oncol Nurs

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Central venous access devices (CVADs) are the standard of care in pediatric oncology. Occlusion is a common complication that can lead to delays in therapy, readmission, and CVAD removal and reinsertion. Early treatment of partial occlusions using a standardized protocol may restore patency and increase life span of CVADs. The objective of this study was to develop and evaluate a nurse-led protocol to manage partial CVAD occlusions in pediatric oncology and autologous bone marrow transplant patients. The protocol enabled nurses to manage partially occluded CVADs by administering thrombolytic therapy following an algorithm and patient-specific standing order. The primary outcome was time from recognition of the partial occlusion to instillation of a thrombolytic. Secondary outcomes were thrombolytic dwell time, number of complete occlusions, and CVAD life span. We used a quasi-experimental, after-only, nonequivalent control group design to compare patients not exposed (retrospective cohort, n = 137) and patients exposed (prospective cohort, n = 101) to the nurse-led protocol. Mann–Whitney U tests were used to compare time to treatment, dwell time, and CVAD life span between cohorts, and χ2 was used to compare the proportion of occlusions classified as complete. Time to treatment was significantly lower in the prospective cohort ( M = 99.9 minutes) versus the retrospective cohort ( M = 483.7 minutes), U = 1366.50, p < .01, as was thrombolytic dwell time, U = 282.50, p < .01. Proportion of complete occlusions and CVAD life span did not differ between cohorts. The nurse-led protocol was effective to manage partial CVAD occlusions in pediatric oncology patients.

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“…Intravenously, tPA is administered as a continuous rate infusion due to its short half‐life, which has been reported to be between 2 and 3 minutes and 16.6 minutes . Although tPA has a short intravascular half‐life, the effect of this drug may be more prolonged in extravascular environments (eg, within central venous catheters) . An increased percentage of partially or fully occluded central venous catheters become patent after a 120 minute dwell time compared to a 30 minute dwell time .…”

Section: Discussionmentioning

confidence: 99%