Treatment of catheter occlusion in pediatric patients

Journal of Parenteral and Enteral Nutrition

Volumn 30, Issue SUPPL. 1, 2006, Pages

  Kerner Jr , John A ^a,b,c   Garcia Careaga, Manuel G ^a,b   Fisher, Amy A ^b   Poole, Robert L ^b  

^a STANFORD UNIVERSITY MEDICAL CENTER   (United States)

^b LUCILE PACKARD CHILDREN S HOSPITAL   (United States)

^c Pediatric Gastroenterology Hepatology and Nutrition   (United States)

Author keywords

[No Author keywords available]

Indexed keywords

ALCOHOL; ALTEPLASE; BICARBONATE; BLOOD CLOTTING FACTOR 10A INHIBITOR; HEPARIN; HYDROCHLORIC ACID; LOW MOLECULAR WEIGHT HEPARIN; PENTASACCHARIDE; PLASMINOGEN ACTIVATOR; RETEPLASE; SODIUM CHLORIDE; SODIUM HYDROXIDE; STREPTOKINASE; UROKINASE; WARFARIN; XIMELAGATRAN;

ACIDITY; ANAPHYLAXIS; BLOOD FLOW; BRAIN HEMORRHAGE; CATHETER OCCLUSION; CATHETER THROMBOSIS; CENTRAL VENOUS CATHETER; CHILD; CLINICAL TRIAL; CONFERENCE PAPER; DEEP VEIN THROMBOSIS; GASTROINTESTINAL HEMORRHAGE; HEPARIN INDUCED THROMBOCYTOPENIA; HUMAN; PARENTERAL NUTRITION; PH; PRIORITY JOURNAL; RISK ASSESSMENT; SEPSIS; SIDE EFFECT; THROMBOGENESIS; VASCULAR ACCESS DEVICE;

CATHETERIZATION, CENTRAL VENOUS; CATHETERS, INDWELLING; CHILD; EQUIPMENT FAILURE; EQUIPMENT FAILURE ANALYSIS; FIBRINOLYTIC AGENTS; HUMANS; THROMBOLYTIC THERAPY; THROMBOSIS; TISSUE PLASMINOGEN ACTIVATOR;

THROMBUS;

EID: 30744473187     PISSN: 01486071     EISSN: None     Source Type: Journal    
DOI: 10.1177/01486071060300S1S73     Document Type: Conference Paper

References (56)

1. Stephens LC, Haire WD, Kotulak GD. Are clinical signs accurate indicators of the cause of central venous catheter occlusion? JPEN J Parenter Enteral Nutr. 1995;19:75-79.
2. Howard L, Ashley C. Management of complications in patients receiving home parenteral nutrition. Gastroenterology. 2003;124:1651-1661.
3. Moureau N, Poole S, Murdock MA, Gray SM, Semba CP. Central venous catheters in home infusion care: outcomes analysis in 50,470 patients. J Vasc Interv Radiol. 2002;13:1009-1016.
4. Gorski LA. Central venous access device occlusions, part 1: thrombotic causes and treatment. Home Healthc Nurse. 2003;21:115-121.
5. Wise M, Richardson D, Lum P. Catheter tip position: a sign of things to come. J Vasc Access Devices. 2001;6:18-26.
6. Grant J. Recognition, prevention, and treatment of home total parenteral nutrition central venous access complications. JPEN J Parenter Enteral Nutr. 2002;26(suppl):S21-S28.
7. National Institutes of Health, Drug Information Service. Management of central venous catheter occlusions. Available at: http: //www.cc.nih.gov/phar/ updates/99nov-dec.html.
8. Gorski LA, Czaplewski LM. Peripherally inserted central catheters. Home Healthc Nurse. 2004;22:758-773.
9. Herbst SL, Kaplan LK, McKinnon BT. Vascular access devices: managing occlusions and related complications in home infusion. Infusion. 1998;4(suppl):S1-S32.
10. Haire WD, Herbst SL. Use of alteplase (t-PA) for the management of thrombotic catheter dysfunction: guidelines from a consensus conference of the National Association of Vascular Access Networks (NAVAN). Nutr Clin Pract. 2000;15:265-275.
11. Timsit JF, Farkas JC, Boyer JM, et al. Central vein catheter thrombosis in intensive care patients: incidence, risk factors, and relationship with catheter-related sepsis. Chest. 1998;114:207-213.
12. US Food and Drug Administration Med Watch. Important safety information letter: dear hospital pharmacy and physician [AstraZeneca, Inc. website]. Available at: http://www.fda. gov/med watch/safety/1999/strept.htm.
13. Haire WD, Atkinson JB, Stephens LC. Urokinase versus recombinant tissue plasminogen activator in thrombosed central venous catheters: a double-blinded, randomized trial. Thromb Haemost. 1994;71:543-547. This double-blind, prospective randomized trial compared the use of a 2 mg dose of alteplase (t-PA) to a 10,000 unit dose of urokinase in 50 dysfunctional catheters radiographically proven to be occluded by thrombus. After up to 2 treatments, t-PA restored function in more catheters than urokinase (89% vs 59%; p = .013). Radiographic contrast injection studies confirmed the complete resolution of the occlusion in almost twice as many t-PA treated catheters (61%) as urokinase-treated catheters (32%). Cochrane Library Level: 2
14. Ponec D, Irwin D, Haire WD, Hill PA, Li X, McCluskey ER, for the COOL Investigators. Recombinant tissue plasminogen activator (Alteplase) for restoration of flow in occluded central venous access devices: a double-blind placebo-controlled trial-the Cardiovascular thrombolytic to Open Occluded Lines (COOL) Efficacy Trial. J Vasc Interv Radiol. 2001;12:951-955. This trial was a double-blind, randomized, prospective study comparing alteplase (2 mg/2 ml) to placebo in 149 patients. Function was restored in 74% of catheters treated with a single dose of alteplase vs 17% for placebo (p < .0001). Cumulative efficacy after up to 2 doses was 90% with no reported drug-related adverse events. Cochrane Library Level: 2
15. Deitcher SR, Fesen MR, Kiproff PM, et al, for the COOL-2 Investigators. Safety and efficacy of alteplase for restoring function in occluded central venous catheters: results of the Cardiovascular thrombolytic to Open Occluded Lines Trial. J Clin Oncol. 2001;20:317-324.
16. Semba CP, Deitcher SR, Li X, Resnansky L, Tu T, McCluskey ER, for the COOL investigators. Treatment of occluded central venous catheters with alteplase: results in 1,064 patients. J Vasc Interv Radiol. 2002;13:1199-1205.
17. Shen V, Li X, Murdock M, Resnansky L, McCluskey ER, Semba CP, for the COOL Investigators. Recombinant tissue plasminogen activator (alteplase) for restoration of function to occluded central venous catheters in pediatric patients. J Pediatr Hematol Oncol. 2003;25:38-45.
18. Jacobs BR, Haygood M, Hingl J. Recombinant tissue plasminogen activator in the treatment of central venous catheter occlusion in children. J Pediatr. 2001;139:593-596.
19. Fisher AA, Deffenbaugh C, Poole RL, Garcia M, Kerner JA Jr. The use of alteplase for restoring patency to occluded central venous access devices in infants and children. J Infus Nurs. 2004;27:171-174.
20. Choi M, Massicotte P, Marzinotto V, Chan AKC, Holmes JL, Andrew M. The use of alteplase to restore patency of central venous lines in pediatric patients: a cohort study. J Pediatr. 2001;139:152-156.
21. Chesler L, Feusner JH. Use of tissue plasminogen activator (rt-PA) in young children with cancer and dysfunctional central venous catheters: J Pediatr Hematol Oncol. 2002;24:653-656.
22. Svoboda P, Barton P, Barbarash OL, et al. Recombinant urokinase is safe and effective in restoring patency to occluded central venous access devices: a multiple-center international trial. Crit Care Med. 2004;32:1990-1996.
23. Haire WD, Deitcher SR, Mullane KM, et al. Recombinant urokinase for restoration of patency in occluded central venous access devices: a double-blind placebo controlled trial. Thromb Haemost. 2004;92:575-582.
24. Home MK III. Thrombolytics for occluded catheters. Crit Care Med. 2004;32:2146-2147.
25. Owens LD. Reteplase for clearance of occluded venous catheters. Am J Health Syst Pharm. 2002;59:1638-1640.
26. Terrill KR, Lemons RS, Goldsby RE. Safety, dose, and timing of reteplase in treating occluded central venous catheters in children with cancer. J Pediatr Hematol Oncol. 2003;25:864-867.
27. Liu CY, Jain V, Shields AF, Heilbrun LK. Efficacy and safety of reteplase for central venous catheter occlusion in patients with cancer. J Vasc Interv Radiol. 2004;15:39-44. This was an open-label, single-arm, prospective study. Reteplase (0.4 Units) was instilled into cancer patients' dysfunctional CVADs. Of 139 patients, the first-attempt success rate for clearing the catheter after a 30-minute dwell time was 66.9%. The cumulative success rates at 60, 90, and 120 minutes were 88.5%, 94.7%, and 94.7% respectively. Cochrane Library Level: 3
28. Pennington CR, Pithie AD. Ethanol lock in the management of catheter occlusion. JPEN J Parenter Enteral Nutr. 1987;11:507-508.
29. Pennington CR. Management of catheter occlusion [Letter]. JPEN J Parenter Enteral Nutr. 1990;14:551.
30. Erdman SH, McElwee CL, Kramer JM, Zuppan CW, White JJ, Grill BB. Central line occlusion with three-in-one nutrition admixtures administered at home. JPEN J Parenter Enteral Nutr 1994;18:177-181.
31. Werlin SL, Lausten T, Jessen S, et al. Treatment of central venous catheter occlusions with ethanol and hydrochloric acid. JPEN J Parenter Enteral Nutr. 1995;19:416-418. The authors developed a standard protocol for pediatric patients for the treatment with HCl and EtOH for urokinase resistant CVAD occlusions. Patency was restored in 34 of 39 catheters using 0.55 mL/kg (up to 3 mL) of 70% EtOH for lipid occlusions and up to 3 mL of 0.1 NHCl (up to 1 mL in infants between 1 and 3 kg) for mineral and drug precipitates. Cochrane Library Level: 5
32. ter Borg F, Timmer J, de Kam SS, Sauerwein HP. Use of sodium hydroxide to clear partially occluded vascular access ports. JPEN J Parenter Enteral Nutr. 1993;17:289-291.
33. Garcia MG, Poole RL, Rubin GD, Kerner JA Jr. Successful use of repeated ethanol injections to clear a central venous catheter occlusion after urokinase failure. J Pediatr Pharm Pract. 1999;4:152-156.
34. Dannenberg C, Bierbach U, Rothe A, Beer J, Korholz D. Ethanol-lock technique in the treatment of bloodstream infection in pediatric oncology patients with Broviac catheter. J Pediatr Hematol Oncol. 2003;25:616-621.
35. Metcalf SCL, Chambers ST, Pithie AD. Use of ethanol locks to prevent recurrent line sepsis. J Infect. 2004;49:20-22.
36. Shulman RJ, Reed T, Pitre D, Laine L. Use of hydrochloric acid to clear obstructed central venous catheters. JPEN J Parenter Enteral Nutr. 1988;12:509-510.
37. Breaux CW Jr, Duke D, Georgeson KE, Mestre JR. Calcium phosphate crystal occlusion of central venous catheters used for total parenteral nutrition in infants and children: presentation and treatment. J Pediatr Surg. 1987;9:829-832.
38. Duffy LF, Kerzner B, Gebus V. Treatment of central venous catheter occlusions with hydrochloric acid. J Pediatr. 1989;114:1002-1004.
39. Testerman EJ. Restoring patency of central venous catheters obstructed by mineral precipitation using hydrochloric acid. J Vasc Nurs. 1991;1:22.
40. Holcombe BJ, Forloines-Lynn S, Garmhausen LW. Restoring patency of long-term central venous access devices. J Intraven Nurs. 1992;15:36-41.
41. Barbaric D, Curtin J, Pearson L, Shaw PJ. Role of hydrochloric acid in the treatment of central venous catheter infections in children with cancer. Cancer. 2004;101:1866-1872.
42. Reed T, Phillips S. Management of central venous catheter occlusions and repairs. J Intraven Nurs. 1996;19:289-294.
43. Harris JL, Maguire D. Developing a protocol to prevent and treat central venous catheter occlusions. J Intraven Nurs. 1999;22:194-198.
44. Infusion Nurses Society. Infusion nursing standards of practice. J Intraven Nurs. 2000;23(suppl 6):1-88.
45. Rummel MA, Donnelly PJ, Fortenbaugh CC. Clinical evaluation of a positive pressure device to prevent central venous catheter occlusions: results of a pilot study. Clin J Oncol Nurs. 2001;5:261-265.
46. LeDuc K. Efficacy of normal saline solution versus heparin solution for maintaining patency of peripheral intravenous catheters in children. J Emerg Nurs. 1997;23:306-309.
47. Stephens LC, Haire WD, Tarantolo S, et al. Normal saline versus heparin flush for maintaining central venous catheter patency during apheresis collection of peripheral blood stem cells (PBSC). Transfus Sci. 1997;18:187-193.
48. Kamala F, Boo NY, Cheah FC, Birinder K. Randomized controlled trial of heparin for prevention of blockage of peripherally inserted central catheters in neonates. Acta Paediatr. 2002;91:1350-1356.
49. Randolf AG, Cook DJ, Gonzales CA, Andrew M. Benefit of heparin in central venous and pulmonary artery catheters: a meta-analysis of randomized controlled trials. Chest. 1998;113:165-171. This study is a very careful meta-analysis of 12 clinical trials of prophylactic heparin. There was a trend for heparin to be beneficial in preventing catheter thrombi or fibrin sleeves; however, this finding did not reach statistical significance. In contrast, heparin effectively reduced catheter-related venous thrombosis by 57%. Heparin also significantly decreased the bacterial colonization of the catheter, and there was a strong reduction in catheter-related bacteremia. Cochrane Library Level:1
50. Krafte-Jacobs B, Sivit CJ, Mejia R, Pollack MM. Catheter-related thrombosis in critically ill children: comparison of catheters with and without heparin bonding. J Pediatr. 1995;126:50-54.
51. Laster JL, Nichols WK, Silver D. Thrombocytopenia associated with heparin-coated catheters in patients with heparin-associated antiplatelet antibodies. Arch Intern Med. 1989;149:2285-2287.
52. Bern MM, Lokich JJ, Wallach SR, et al. Very low doses of warfarin can prevent thrombosis in central venous catheters: a randomized prospective trial. Ann Intern Med. 1990;112:423-428.
53. Geerts WH, Jeit JA, Clagett GP, et al. Prevention of venous thromboembolism. Chest. 2001;119(suppl 1):132S-175S.
54. Andrew M, Marzinotto V, Pencharz P, et al. A cross-sectional study of catheter-related thrombosis in children receiving total parenteral nutrition at home. J Pediatr. 1995;126:358-363.
55. Kuter DJ. Thrombotic complications of central venous catheters in cancer patients. Oncologist. 2004;9:207-216.
56. Jacobs BR. Central venous catheter occlusion and thrombosis. Crit Care Clin. 2003;19:1-22.