Catheter dysfunction can be caused by thrombotic or nonthrombotic occlusions1
Thrombotic occlusions involve the formation of a thrombus, or clot.1
Catheter-related occlusions may be complete or partial.2
- A complete occlusion is easily recognized because neither infusion of fluid nor aspiration of blood can be accomplished.2
- With a partial or "withdrawal" occlusion, fluid can still be infused but fluid return cannot be accomplished3,4
Example of a Partial/Withdrawal Occlusion2
Fibrin tail allowing infusion
Beginning to flap back with start of withdrawal
Blocking aspiration of the catheter
Photos © Penny Offer, CRNI
A thrombotic occlusion may be found within or around the catheter or in the surrounding vessel.3 Fibrin buildup, a natural consequence of catheter placement, contributes to thrombus formation.4-6 In addition, there are both patient-related and catheter-related risk factors for thrombosis.3,7,8
- Occurs when blood refluxes inside the catheter lumen
- Common causes of reflux include patient coughing, inadequate flushing after blood draws or after checking for blood return, and improper use of flush syringes
- Extends out from the catheter tip but is drawn inward, blocking opening of the catheter lumen on aspiration attempts
- Results in the ability to infuse fluids but inability to get blood return
- Forms where the catheter touches or "rubs" the vein wall
- Common sites are the entry site, anywhere along catheter path, and catheter tip
- Forms when fibrin adheres to the external catheter surface, often beginning at the entry site, and may encase all or part of the catheter like a sock
- May completely cover the opening of the catheter tip
Nonthrombotic occlusions may be related to1:
- Mechanical problems
- Malpositioned tip placement
- Infusate precipitates or residue
Mechanical problems, such as kinked tubing or constricting sutures, are often readily identified and corrected. Several safe and effective techniques may be used to restore function to a catheter that has become malpositioned, including repositioning the patient, rapid flushing of the line, fluoroscopic catheter guidance, or use of a thrombolytic. Most precipitates and residues can be effectively treated depending upon their source.3
Indication
Cathflo Activase (Alteplase) is indicated for the restoration of function to central venous access devices (CVADs) as assessed by the ability to withdraw blood.
Safety Information
Cathflo Activase should not be administered to patients with known hypersensitivity to Alteplase or any component of the formulation.
In clinical trials, the most serious adverse events reported after treatment were sepsis, gastrointestinal bleeding, and venous thrombosis.
Please click here for full prescribing information.
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National Institutes of Health. Management of central venous catheter occlusions. Pharm Update. 1999:1-4.
Ryder M. The role of biofilm in vascular catheter-related infections. New Dev Vasc Dis. 2001;2:15-25.
Hadaway LC. Reopen the pipeline. Nursing. 2005;35:54-61.
Herbst SL. Options for venous access in ambulatory care: issues in selection and management.
J Infus Chemother. 1996;6:186-194.McKnight S. Nurse's guide to understanding and treating thrombotic occlusion of central venous access devices. Medsurg Nurs. 2004;13:377-382.
Wingerter L. Vascular access device thrombosis. Clin J Oncol Nurs. 2003;7:345-348.
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.
