Clogbusting: time for a concerted approach to catheter occlusions?

Abstract

Catheter occlusion is a common problem costing considerable time and money for patients and healthcare professionals, requiring pro-action rather than reaction. None of the existing approaches is a complete answer, and further, coordinated research effort is needed. Endoluminal brushing is gradually gaining acceptance as a 'catch-all' solution once the catheter malfunctions, but understanding how and why catheters become blocked, and developing strategies to prevent occlusion would be a more scientific approach.

Treatment of intestinal failure: home parenteral nutrition

“…Catheter occlusion is a common problem, and has been reported to occur in up to 25% of all central venous catheters at some point during their use. 71 Complete occlusion of the superior vena cava and subclavian veins is common in patients with hypercoagulable states, and in other patients after several years of central vein catheterization ( Figure 5). 51 The risk factors for thrombotic occlusion include the presence of a hypercoagulable state, mesenteric vein thrombosis, malignancies, and catheter kinking or placement against a vessel wall.…”

“…73 Long-term heparin given with the TPN should be avoided, because it is incompatible with the lipids in the TPN, increases the risk of osteoporosis and can cause thrombocytopenia. 71 Additionally, no studies have shown a difference (in terms of the incidence of catheter thrombosis) between the use of heparin and saline flushes. 71 Once lines occlude, however, various fibrinolytic agents have proven effective in the re-establishment of catheter patency.…”

“…71 Additionally, no studies have shown a difference (in terms of the incidence of catheter thrombosis) between the use of heparin and saline flushes. 71 Once lines occlude, however, various fibrinolytic agents have proven effective in the re-establishment of catheter patency. In 2001, a double-blind, placebo-controlled trial demonstrated that the less-expensive recombinant tissue plasminogen activator reteplase (Boehringer Mannheim, IN, USA) was superior to alteplase (Genentech Inc., CA USA) in re-establishing line patency, with an overall success rate of 74%.…”

“…51 The risk factors for thrombotic occlusion include the presence of a hypercoagulable state, mesenteric vein thrombosis, malignancies, and catheter kinking or placement against a vessel wall. 71 Other types of occlusion are caused by chemical precipitates or drug precipitates in the TPN formula, and lipid residue. 71 Studies from the 1980s suggested that lowdose warfarin (e.g.…”

“…71 Other types of occlusion are caused by chemical precipitates or drug precipitates in the TPN formula, and lipid residue. 71 Studies from the 1980s suggested that lowdose warfarin (e.g. 5 mg per day) reduced the rates of catheter blockage due to thrombosis.…”