Calcium phosphate crystal occlusion of central venous catheters used for total parenteral nutrition in infants and children: Prevention and treatment

Effect of heparin and other factors associated with complications of peripherally inserted central venous catheters in neonates

“…These include catheter diameter (gauge), location of catheter tip, fluid infusion rate, dwell time, length of catheter outside the skin and precipitation of calcium and phosphate salts within the tubing. [4][5][6]8,15,16 Although the concentration of heparin used in the first epoch of this study (0.25 to 0.5 units ml À1 ) is low, the dose (0.5 to 2 units kg À1 per h) is comparable to recent reports using 'low-dose' (0.5 units kg À1 per h) heparin. 4,5 Compared with reports by Uslu et al 4 and Shah et al, 5 however, the complication rates observed in the cohorts in both the epochs of this study were lower, and removal of heparin from continuous infusions did not result in an increased rate of occlusion or a decreased duration of use.…”

Particulate Matter in Injectable Drugs: Evaluation of Risks to Patients

“…These studies performed on animal models deserve deeper investigation and reference to human patients, especially paediatric patients. For children, the clinical consequences of particulate matter have been reported in several studies, leading to severe complications [107] or death [58,108].…”

Recommendations for the use of long-term central venous catheter (CVC) in children with hemato-oncological disorders: management of CVC-related occlusion and CVC-related thrombosis. On behalf of the coagulation defects working group and the supportive therapy working group of the Italian Association of Pediatric Hematology and Oncology (AIEOP)

“…The causes of obstruction may be mechanical, chemical (drugs or nutrients, precipitating in the lumen), or thrombotic [4,5,[11][12][13][14][15][16][17]. One of the most frequent causes of CVC dysfunction and occlusion is the formation of a fibrin sheath inside the lumen or at the apex of the catheter, especially in that case without apparent signs of compression or of dislocation, and without a history of infusions of drugs at risk of giving precipitates (i.e., TPN, etoposide, etc.).…”

“…The use of sodium hydroxide (NaOH) 0.1 M is suggested to recover the function of the CVC blocked by basic substances as lipids [5,11], also by continuous infusion lasting up to 15 h [5,11,29,30]. The use of hydrochloric acid (HCl) 0.1 N is an effective solution to solve the blocking of the catheter due to precipitates of calcium phosphate crystals or acidic substances [5,11,13,31,32].…”

“…The use of hydrochloric acid (HCl) 0.1 N is an effective solution to solve the blocking of the catheter due to precipitates of calcium phosphate crystals or acidic substances [5,11,13,31,32]. Recent data show that HCl ≤2 M does not damage silicone CVC [33][34][35].…”