Treatment of catheter occlusion in pediatric patients.
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.
Kerner
John A
JA
Division of Pediatric Gastroenterology, Hepatology, and Nutrition, Department of Pediatrics, Stanford University Medical Center, Stanford, California 94304, USA. jkerner@stanfordmed.org
Garcia-Careaga
Manuel G
MG
Fisher
Amy A
AA
Poole
Robert L
RL
D002405:Catheterization, Central Venous / Q000009:adverse effects*; D002408:Catheters, Indwelling; D002648:Child; D004868:Equipment Failure; D019544:Equipment Failure Analysis; D005343:Fibrinolytic Agents / Q000627:therapeutic use*; D006801:Humans; D015912:Thrombolytic Therapy; D013927:Thrombosis / Q000188:drug therapy / Q000517:prevention & control*; D010959:Tissue Plasminogen Activator / Q000627:therapeutic use*
D005343:Fibrinolytic Agents; D010959:Tissue Plasminogen Activator