Use of Hydrochloric Acid to Clear Obstructed Central Venous Catheters

Shulman, Robert J.; Reed, Theresa; Pitre, Douglas; Laine, Laura

doi:10.1177/0148607188012005509

Cited by 57 publications

(20 citation statements)

References 3 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…Although the rate of occlusion, at 16%, was comparable to other studies (9% [2], 7% [3], 40% [4], 11% [5]) our rate of salvage, once blocked, was low. Other centres have shown that an occluded TIVAD may be saved by injecting urokinase [4] or hydrochloric acid 0.1 M [7] through it, with a potential success rate of up to 96% [4]. We did not find this possible, owing to rupture or disconnection of the catheter.…”

Section: Discussionmentioning

confidence: 59%

Totally implantable venous access devices in cystic fibrosis: complications and patients' opinions

Rodgers¹,

Liddle²,

Nixon³

et al. 1998

Eur Respir J

View full text Add to dashboard Cite

The introduction of totally implantable venous access devices (TIVAD) has provided a solution to difficult venous access in patients with cystic fibrosis. Early reports have, however, recognized a number of complications with their use. We report our experience with five devices used over 8 yrs with regard to complications and patient attitudes. Patients' notes were reviewed to record the details of TIVAD insertion, duration of function, and complications. In January 1996 the surviving 30 patients were surveyed on their attitudes to TIVAD and complications by written questionnaire. Sixty one ports were implanted in 42 patients (aged 16-47 yrs) between June 1988 and January 1996, giving a total of 1,510 patient-months' experience. The duration of function ranged from 2 weeks to 6 yrs. Survival analysis showed that the median survival of ports was 53 months, 42 out of 61 (69%) had not failed in service at the end of follow-up or patient death. Twenty-three complications occurred in 19 patients. These included: line occlusion (10 patients), venous thrombosis (4), difficult access (3), infection (2), cellulitis (1), inversion of port chamber (2) and pneumothorax (1). The questionnaire showed that patients had strong views on the positioning of their port. Lifestyle issues included interference with seatbelts (8 patients), sport (4), clothing (2), sexual relations (2) and cosmetic appearance (15). Complication rates were similar to those in other studies, although infection rates and salvage of an occluded port were lower. The survey highlighted a number of lifestyle issues, with cosmetic appearance deemed unsatisfactory by half of the patients. However, the majority (28 out of 30) believed their totally implantable venous access devices to be a better alternative to cannulae or long lines.

show abstract

Section: Discussionmentioning

confidence: 59%

Totally implantable venous access devices in cystic fibrosis: complications and patients' opinions

Rodgers¹,

Liddle²,

Nixon³

et al. 1998

Eur Respir J

View full text Add to dashboard Cite

show abstract

“…This small amount is unlikely to cause a metabolic acidosis. 36 Breaux et al 37 Of further interest is a fascinating study from Canada. In a retrospective review, 42 pediatric oncology patients at the Children's Hospital at Westmead, Canada, received IV antibiotics and 2-M HCl between 1994 and 2000.…”

Section: Nonthrombotic Catheter Occlusionmentioning

confidence: 99%

“…Acidic drugs such as vancomycin and etoposide can be cleared using 0.1-N hydrochloric acid (0.1-N HCl) 39 ; 0.1-N HCl was also used to clear a catheter occlusion secondary to the sequential administration of amikacin, piperacillin, vancomycin, and heparin. 36 When the occlusion is suspected to be the result of basic medications (eg, ticarcillin, oxacillin, heparin, phenytoin, imipenem) it can be cleared with sodium bicarbonate (1 mL of 1 mEq/mL) 40 or 0.1-N NaOH. 42 Shulman et al 36…”

Section: Nonthrombotic Catheter Occlusionmentioning

confidence: 99%

Treatment of Catheter Occlusion in Pediatric Patients

Kerner

Garcia-Careaga

Fisher

et al. 2006

J Parenter Enteral Nutr

View full text Add to dashboard Cite

A proper initial assessment of catheter occlusion is the key to successful management. The assessment screens are for both thrombotic and nonthrombotic causes (including mechanical occlusion). If mechanical occlusion is excluded, thrombotic occlusion is treated with alteplase. Nonthrombotic occlusions are treated according to their primary etiologies: lipid occlusion is treated with 70% ethanol, mineral precipitates are treated with 0.1-N hydrochloric acid (HCl), drug precipitates are treated according to their pH-acidic drugs can be cleared with 0.1-N HCl, basic medications can be cleared with sodium bicarbonate or 0.1-N sodium hydroxide (NaOH). Prevention of occlusion of central venous access devices is also critical. To date, no data conclusively show heparin flushes to be superior to saline flushes. No prophylactic regimen, including low-dose warfarin, low-molecular-weight heparin, or 1 unit heparin/mL of parenteral nutrition has been endorsed by any major medical, nursing, or pharmacy group due to lack of scientific evidence. The most encouraging information on decreasing occlusion rate comes from experience with positive-pressure devices that attach to the hub of most catheter lumens and prevent retrograde blood flow and, consequently, decrease the risk of thrombus formation in the catheter lumen.

show abstract

“…Appropriate treatment depends on the suspected cause of the occlusion. Obstructions thought to be caused by precipitation of low-pH medications or calcium phosphate crystals that become insoluble in basic solutions can be treated with 0.1% hydrochloric acid 26–28,31,32. Although our center still uses this method, the practice has been discontinued in some institutions because of concern about damaging the wall of the catheter.…”

Section: Introductionmentioning

confidence: 99%

Management of occlusion and thrombosis associated with long-term indwelling central venous catheters

et al. 2009

View full text Add to dashboard Cite

Long-term central venous catheters (CVC) facilitate care for patients with chronic illnesses, but catheter occlusions and catheter-related thrombosis (CRT) are common complications. This review summarizes management of CVC and CRT. Mechanical CVC occlusions require cause-specific therapy; whereas, thrombotic occlusions usually resolve with thrombolytic therapy, such as alteplase. Prophylaxis with thrombolytic flushes may decrease CVC infections and CRT, but confirmatory studies and cost-effectiveness analysis are needed. Risk factors for CRT include previous catheter infections, malposition of the catheter tip, and prothrombotic states. CRT can lead to catheter infection, pulmonary embolism, and post-thrombotic syndrome. CRT is diagnosed primarily using Doppler ultrasound or venography and treated with anticoagulation for 6 weeks to a year, depending on the extent of the thrombus, response to initial therapy, and whether thrombophilic factors persist. Prevention of CRT includes proper positioning of the CVC and prevention of infections; anticoagulation prophylaxis is not recommended at present.

show abstract

Use of Hydrochloric Acid to Clear Obstructed Central Venous Catheters

Cited by 57 publications

References 3 publications

Totally implantable venous access devices in cystic fibrosis: complications and patients' opinions

Totally implantable venous access devices in cystic fibrosis: complications and patients' opinions

Treatment of Catheter Occlusion in Pediatric Patients

Management of occlusion and thrombosis associated with long-term indwelling central venous catheters

Contact Info

Product

Resources

About