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Treatment of Catheter Occlusion in Pediatric Patients

John A. Kerner, Jr, MD^*,, Manuel G. Garcia-Careaga, MD^*,, Amy A. Fisher, MS, RN, CNSN and Robert L. Poole, PharmD

From the ^* Division of Pediatric Gastroenterology, Hepatology, and Nutrition, Department of Pediatrics, Stanford University Medical Center, Stanford, California; and the Department of Pharmacy, Lucile Packard Children's Hospital, Palo Alto, California

Correspondence: John A. Kerner, Jr, MD, Division of Pediatric Gastroenterology, 750 Welch Road, Suite 116, Palo Alto, CA 94304. Electronic mail may be sent to jkerner{at}stanfordmed.org.

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.

Journal of Parenteral and Enteral Nutrition, Vol. 30, No. 1 suppl, S73-S81 (2006)
DOI: 10.1177/01486071060300S1S73


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