Implications for catheter management

Because central venous lines are critical for delivering intravenous therapies and allowing for the withdrawal of blood samples, their proper function must be maintained.

Catheter occlusions may lead to complications, such as1,2:

Interruption of therapy
Infiltration or extravasation
Infection
Increased cost of treatment

Assessing catheter function

As supported by major professional organizations, catheter patency should be assessed prior to every infusion to avoid complications that may arise from attempts to infuse into an occluded or misplaced catheter.3-5

"The nurse should aspirate the catheter for positive blood return to confirm patency prior to administration of medications and solutions."3 — Infusion Nurses Society 2006 Standards of Practice

When a catheter is found to be occluded, the main goal is to restore function in a timely and cost-effective manner, with minimal risk to the patient. Whenever possible, salvage the catheter.1,6-9

Benefits of salvage vs replacement of occluded catheters1,6:

Less disruptive to therapy
Reduces patient discomfort/trauma
Preserves number of available sites for future use
Eliminates risk of complications related to insertion
Limits extra costs related to device replacement and potential for increased length of stay

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References:

Hadaway LC. Reopen the pipeline. Nursing. 2005;35:54-61.
Mayo DJ, Pearson DC. Chemotherapy extravasation: a consequence of fibrin sheath formation around venous access devices. Oncol Nurs Forum. 1995;22:675-680.
Infusion Nurses Society. Infusion nursing standards of practice. J Infus Nurs. 2006;29(suppl 1S):S1-S92.
Association for Vascular Access (AVA) Save That Line! campaign. Available at www.avainfo.org/website/article/asp?id=40777. Accessed July 29th, 2008.
Camp-Sorrell D, ed. Access Device Guidelines. Recommendations for Nursing Practice and Education. 2nd Ed. Pittsburgh, PA: Oncology Nursing Society, 2004.
Haire WD, Herbst SF. Consensus conference on the use of alteplase (t-PA) for the management of thrombotic catheter dysfunction. J Vasc Access Devices. Highlights Bulletin: Summer 2000;1-8.
Herbst SL. Options for venous access in ambulatory care: issues in selection and management. J Infus Chemother. 1996;6:186-194.
O'Grady NP, Alexander M, Dellinger EP, et al. Guidelines for the prevention of intravascular catheter-related infections. Pediatrics. 002;110:e51; also published as O'Grady NP, Alexander M, Dellinger EP, et al. Guidelines for the prevention of intravascular catheter-related infections. Centers for Disease Control and Prevention. MMWR Recomm Rep. 2002; 51:1-26.
Kokotis K. Cost containment and infusion services. J Infus Nurs. 2005;28:S22-S32.