Mechanism and Management of Persistent Withdrawal Occlusion

Tschirhart, James; Rao, Minoo K.; Gruenberg, James C.

doi:10.1097/00003246-198704000-00090

Cited by 17 publications

(17 citation statements)

References 0 publications

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“…Catheter occlusions occur less frequently in ports when compared to external catheters, such as Broviac and Hickman catheters, with an even lower frequency in peripherally inserted central catheter (PICC) lines. [1][2][3]5,[18][19][20] CVCs with more than one lumen are associated with an increased risk of clot. The location of the tip of the CVC is also important: the more distal the location of the CVC tip, the higher the risk of obstruction.…”

Section: Types Of Catheter Obstructionmentioning

confidence: 99%

“…[1][2][3][4][5][6] Occlusion can be classified as partial (inability to aspirate blood but ability to infuse through the catheter) or complete (inability to aspirate or infuse via the catheter). Although CVC obstruction is considered to be a clinically important issue according to 80% of pediatric oncology centers surveyed in the United Kingdom, differences in prevention, diagnosis, and treatment practices persist due to lack of evidence-based management guidelines.…”

Section: Introductionmentioning

confidence: 99%

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Thrombolytic therapy for central venous catheter occlusion

Baskin¹,

Reiss²,

Wilimas³

et al. 2011

Haematologica

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BackgroundLong-term central venous catheters have improved the quality of care for patients with chronic illnesses, but are complicated by obstructions which can result in delay of treatment or catheter removal. Design and MethodsThis paper reviews thrombolytic treatment for catheter obstruction. Literature from Medline searches using the terms "central venous catheter", "central venous access device" OR "central venous line" associated with the terms "obstruction", "occlusion" OR "thrombolytic" was reviewed. Efficacy of thrombolytic therapy, central venous catheter clearance rates and time to clearance were assessed. ResultsAlteplase, one of the current therapies, clears 52% of obstructed catheters within 30 min with 86% overall clearance (after 2 doses, when necessary). However, newer medications may have higher efficacy or shorter time to clearance. Reteplase cleared 67-74% within 30-40 min and 95% of catheters overall. Occlusions were resolved in 70 and 83% of patients with one and 2 doses of tenecteplase, respectively. Recombinant urokinase cleared 60% of catheters at 30 min and 73% overall. Alfimeprase demonstrated rapid catheter clearance with resolution in 40% of subjects within 5 min, 60% within 30 min, and 80% within 2 h. Additionally, urokinase prophylaxis decreased the incidence of catheter occlusions from 16-68% in the control group to 4-23% in the treatment group; in some studies, rates of catheter infections were also decreased in the urokinase group. ConclusionsThrombolytic agents successfully clear central venous catheter occlusions in most cases. Newer agents may act more rapidly and effectively than currently utilized therapies, but randomized studies with direct comparisons of these agents are needed to determine optimal management for catheter obstruction.

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Section: Types Of Catheter Obstructionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Thrombolytic therapy for central venous catheter occlusion

Baskin¹,

Reiss²,

Wilimas³

et al. 2011

Haematologica

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“…7,13,14,[32][33][34] A trial comparing mechanical manipulation versus catheter exchange showed that tunneled hemodialysis catheters with over-the-wire exchange is superior to percutaneous fibrin sheath stripping in short-and long-term (4 months) patency rates. 18 Gray et al compared mechanical manipulation versus thrombolysis and demonstrated that urokinase in central dialysis catheters is equal to fibrin sheath stripping in the short term (45 days).…”

Section: Discussionmentioning

confidence: 99%

Local Low-Dose Thrombolysis for Safe and Effective Treatment of Venous Port-Catheter Thrombosis

et al. 2014

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“…Fibrin sheath may also interfere with attempts to aspirate blood during routine catheter flushing and sampling of blood for diagnostic testing, a condition that has been termed â€oe¿ persistent withdrawalocclusionâ€• [4]. During the appli cation of syringe suction, fibrin sheath is pulled up in ballâ€"valvefashion and occludes the exit site(s).…”

Section: Clinical Manifestations and Differential Diagnosismentioning

confidence: 99%