title: Central venous catheter occlusion: a prospective, controlled trial examining the impact of a positive-pressure valve device.
abstract: BACKGROUND
  Central venous catheter (CVC) occlusion occurs frequently in children. This problem is often associated with disruption of intravascular therapy and monitoring. Multiple factors may predispose to catheter occlusion, but reflux of blood into the catheter lumen is a common factor. We hypothesized that use of a positive pressure valve device would reduce the incidence of catheter occlusion.
  
  
  METHODS
  In phase I of this sequential study design, newly placed CVCs were capped with a standard device. In Phase II, CVCs were capped with a positive-pressure valve device. Data collected included patient demographics, type of catheter, infusate, catheter duration, and complications. Partial and complete catheter occlusions were delineated. A user satisfaction survey was conducted.
  
  
  RESULTS
  There were 153 children (mean age 48.0 +/- 7.7 months) with 312 CVC lumens enrolled in the study. Mean catheter duration was 9.4 +/- 0.9 days. There were fewer complete occlusions in CVCs capped with the positive pressure valve device than with the standard device [6/161 (3.7%) vs 18/151 (11.9%) occlusions, respectively; p = .012)]. There were no significant differences in partial occlusions, phlebitis, or catheter-related bloodstream infection between the 2 groups.
  
  
  CONCLUSIONS
  CVCs with a positive-pressure valve cap device have a lower incidence of complete catheter occlusion than those with a standard cap device.
authors.affiliation: Division of Critical Care Medicine, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio 45229, USA. jacobs@chmcc.org
authors.forename: Brian R
authors.initials: BR
authors.lastname: Jacobs
authors.forename: Susan
authors.initials: S
authors.lastname: Schilling
authors.forename: Darcy
authors.initials: D
authors.lastname: Doellman
authors.forename: Nancy
authors.initials: N
authors.lastname: Hutchinson
authors.forename: Melissa
authors.initials: M
authors.lastname: Rickey
authors.forename: Shannen
authors.initials: S
authors.lastname: Nelson
mesh_terms: D002405:Catheterization, Central Venous / Q000009:adverse effects / Q000295:instrumentation* / Q000379:methods*; D002675:Child, Preschool; D004866:Equipment Contamination; D004867:Equipment Design; D004868:Equipment Failure; D005260:Female; D006801:Humans; D007239:Infections / Q000453:epidemiology; D008297:Male; D011446:Prospective Studies