Management of occlusion and thrombosis associated with long-term indwelling central venous catheters.
Long-term central venous catheters (CVCs) are important instruments in the care of patients with chronic illnesses, but catheter occlusions and catheter-related thromboses are common complications that can result from their use. In this Review, we summarise management of these complications. Mechanical CVC occlusions need cause-specific treatment, whereas thrombotic occlusions usually resolve with thrombolytic treatment, such as alteplase. Prophylaxis with thrombolytic flushes might prevent CVC infections and catheter-related thromboses, but confirmatory studies and cost-effectiveness analysis of this approach are needed. Risk factors for catheter-related thromboses include previous catheter infections, malposition of the catheter tip, and prothrombotic states. Catheter-related thromboses can lead to catheter infection, pulmonary embolism, and post-thrombotic syndrome. Catheter-related thromboses are usually diagnosed by Doppler ultrasonography or venography and treated with anticoagulation therapy for 6 weeks to a year, dependent on the extent of the thrombus, response to initial therapy, and whether thrombophilic factors persist. Prevention of catheter-related thromboses includes proper positioning of the CVC and prevention of infections; anticoagulation prophylaxis is not currently recommended.
Baskin
Jacquelyn L
JL
Department of Oncology and International Outreach Program, St Jude Children's Research Hospital, Memphis, TN 3105-2794, USA.
Pui
Ching-Hon
CH
Reiss
Ulrike
U
Wilimas
Judith A
JA
Metzger
Monika L
ML
Ribeiro
Raul C
RC
Howard
Scott C
SC
D000465:Algorithms; D000925:Anticoagulants / Q000627:therapeutic use; D001696:Biomechanical Phenomena; D002405:Catheterization, Central Venous / Q000009:adverse effects*; D002408:Catheters, Indwelling / Q000009:adverse effects*; D002985:Clinical Protocols; D003663:Decision Trees; D004868:Equipment Failure; D005343:Fibrinolytic Agents / Q000627:therapeutic use; D006801:Humans; D010690:Phlebography; D017410:Practice Guidelines as Topic; D011322:Primary Prevention; D012307:Risk Factors; D007507:Therapeutic Irrigation; D013927:Thrombosis / Q000175:diagnosis / Q000209:etiology / Q000628:therapy; D018608:Ultrasonography, Doppler
D000925:Anticoagulants; D005343:Fibrinolytic Agents