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Use of Sodium Hydroxide Solution to Clear Partially Occluded Vascular Access Ports

Department of Internal Medicine, Academical Medical Center of the University of Amsterdam

John Timmer, PHARMD

Department of Pharmacy, Academical Medical Center of the University of Amsterdam

Suze S. De Kam, RN

Department of Home Total Parenteral Nutrition Nursing and Training Unit, Academical Medical Center of the University of Amsterdam

Hans P. Sauerwein, MD, PHD

Department of Internal Medicine, Academical Medical Center of the University of Amsterdam, Department of Home Total Parenteral Nutrition Nursing and Training Unit, Academical Medical Center of the University of Amsterdam

Gradual vascular access port or tunneled central venous catheter occlusion during total parenteral nutrition is a common complication of unknown etiology, usually unresponsive to treatment with urokinase, ethanol, or hydrochloric acid. After establishing safety with regard to catheter materials and efficacy in dissolving the occluding substance in vitro, we treated a total of 13 vascular access ports (10 patients) that had occluded gradually during "three-in-one" total parental nutrition by slow perfusion with 10 to 20 mL of 0.1 mmol/mL sodium hydroxide solution. We found a mean increase in flow (results are flow rates under gravity-dependent vascular access port inlet pressure of 1.5 kPa) from 37 µL/s (95% upper confidence limit, 45 µL/s) to 75 µL/s (95% lower confidence limit, 64 µL/s; p < .001). For normal use, a flow of 50 µL/s is sufficient. There were no side effects. Five vascular access ports remained in excellent function during a follow-up period of 9 months. The others had reocclusions, but the partial reocclusions could be treated successfully. (Journal of Parenteral and Enteral Nutrition 17:289-291, 1993)

Journal of Parenteral and Enteral Nutrition, Vol. 17, No. 3, 289-291 (1993)
DOI: 10.1177/0148607193017003289


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