Recognizing Occlusions

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Ensuring catheter patency is vital to delivering life-sustaining therapies

Central line function should be routinely assessed

Occluded catheters may be responsible for interruptions in therapy, delays in discharge, or additional procedures, such as catheter replacement.5,11

Learn to recognize the signs of central venous access device (CVAD) occlusion, which can include1,11:

  • Inability to withdraw blood or sluggish blood return
  • Sluggish flow
  • Inability to flush or infuse through the CVAD
  • Frequent occlusion alarms on electronic infusion device
  • Infiltration/extravasation or swelling/leaking at the infusion site

In adult patients, with a blood flow through the SVC of approximately 2 liters per minute, a free-flowing blood return should be readily achievable.14 Lack of blood return or a sluggish flow may indicate a catheter occlusion or a malpositioned tip, and further assessment of the line will be necessary.1

Superior vena cava

A CVAD that exhibits any of these signs requires further assessment and possible treatment. Note that, according to the AVA Best Practice Guidelines, the risk of occlusion is higher for pediatric patients than in adults, because of the use of smaller catheter sizes, lower infusion rates, and significantly smaller lumen volumes.2,11

AVA=Association for Vascular Access; SVC=superior vena cava.

NEXT: Learn how to ensure central line patency >

Stethoscope

The INS Infusion Therapy Standards of Practice state that catheter salvage is preferred over catheter removal for management of central venous access device (CVAD) occlusions.1

Indication

Cathflo® Activase® (alteplase) is indicated for the restoration of function to central venous access devices as assessed by the ability to withdraw blood.

Contraindications

Cathflo Activase should not be administered to patients with known hypersensitivity to alteplase or any component of the formulation.

Precautions
General

Certain causes of catheter dysfunction should be considered before treatment with Cathflo Activase (e.g. catheter malposition, mechanical failure, constriction by a suture and lipid deposits or drug precipitates within the catheter lumen). These types of conditions should be considered before treatment with Cathflo Activase.

Excessive pressure should be avoided when Cathflo Activase is instilled into the catheter. Such force could cause rupture of the catheter or expulsion of the clot into the circulation.

Bleeding

The most frequent adverse reaction associated with all thrombolytics in all approved indications is bleeding. Cathflo Activase has not been studied in patients known to be at risk for bleeding events that may be associated with the use of thrombolytics. Caution should be exercised with patients who have any condition for which bleeding constitutes a significant hazard.

Should serious bleeding in a critical location (e.g., intracranial, gastrointestinal, retroperitoneal, pericardial) occur, treatment with Cathflo Activase should be stopped and the drug should be withdrawn from the catheter.

Infections

Cathflo Activase should be used with caution in the presence of known or suspected infection in the catheter. Using Cathflo Activase in patients with infected catheters may release a localized infection into the systemic circulation. As with all catheterization procedures, care should be used to maintain aseptic technique.

Hypersensitivity

Hypersensitivity, including urticaria, angioedema and anaphylaxis, has been reported in association with use of Cathflo Activase. Monitor patients treated with Cathflo Activase for signs of hypersensitivity and treat appropriately if necessary.

Drug Interactions and Drug/Laboratory Test Interactions

The interaction of Cathflo Activase with other drugs has not been formally studied. Concomitant use of drugs affecting coagulation and/or platelet function has not been studied.

Potential interactions between Cathflo Activase and laboratory tests have not been studied.

Carcinogenesis, Mutagenesis, Impairment of Fertility

Long-term studies in animals have not been performed to evaluate the carcinogenic potential or the effect on fertility.

Pregnancy

There are no adequate and well-controlled studies in pregnant women. Cathflo Activase should be used during pregnancy only if the potential benefit justifies the potential risk to the fetus.

Adverse Reactions

In clinical trials, the most serious adverse events reported after treatment were sepsis, gastrointestinal bleeding, and venous thrombosis.

You may report side effects to the FDA at (800) FDA-1088 or www.fda.gov/medwatch. You may also report side effects to Genentech at (888) 835-2555.

Please see accompanying full Prescribing Information for additional Important Safety Information.

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