Interventions for restoring patency of occluded central venous catheter lumens

Abstract

There is inadequate evidence to draw strong conclusions on the efficacy or safety of the drug interventions included in this review. There is some low quality evidence from a meta-analysis of two studies investigating urokinase (various strengths) and some very low evidence from two single studies investigating alteplase 2 mg/2 mL that suggest that these two drug interventions may be effective in treating withdrawal or total occlusion of CVC lumens caused by thrombosis. Further high quality, sufficiently powered research is still required to look at the efficacy and safety of urokinase, alteplase and other chemical, surgical and drug interventions for treating CVC lumen occlusion. Research studies which exclusively include child participants are especially warranted.

ESPGHAN/ESPEN/ESPR/CSPEN guidelines on pediatric parenteral nutrition: Venous access

“…Other than this study there is little data to support evidenceebased recommendations for unblocking CVC. Van Miert and colleagues found seven studies that investigated different strengths of thrombolytic and anticoagulant drug interventions for treating catheter occlusion thought to be caused by thrombus [155]. The quality of evidence was low but urokinase appears to be more effective than placebo in restoring patency.…”

Complications of Central Venous Access Devices: A Systematic Review

“…The immediate interruption to necessary treatment results in an inability to receive prescribed chemotherapy, fluids, nutrition, antibiotics, or other necessary medicines. 8,9 CVAD reinsertions are costly, requiring highly skilled staff, large amounts of sterile and disposable equipment, theater time, monitoring devices, and radiologic confirmation of placement. 10 Their insertion can result in complications including pneumothorax, arterial puncture, hemorrhage, and cardiac rhythm dysfunction, 11 with overall CVAD insertion-related complications reported in 7% to 18% of CVAD insertions.…”

“…8,25 CVAD-associated thrombosis may be as a result of fibrin deposited inside the CVADs (intraluminal thrombosis), adhering to the vein wall (mural thrombosis), or around the intravascular portion of the CVADs (fibrin sheath). 9,25 Fibrin sheaths cause malfunction only when the sheath extends around or over the tip of the CVADs, and in many cases CVAD-associated thromboses are asymptomatic and the device continues to function. 25 Individual studies have examined the rate and incidence rate of CVAD failure and complications in pediatrics, but an overall estimation per CVAD type throughout this population has not been established.…”

Complications of indwelling central venous catheters in pediatric liver transplant recipients

“…Among other factors, this can be ascribed to the fact that the ICVC are either accessed by multiple caregivers or conversely are not accessed or cared for at regular intervals. Therefore, when the MD is noted, it is too late for catheter salvage using conventional methods .…”