Thrombolytic therapy for central venous catheter occlusion

Baskin, Jacquelyn; Reiss, Ulrike; Wilimas, Judith A.; Metzger, Monika L.; Ribeiro, Raul C.; Pui, Ching‐Hon; Howard, Scott C.

doi:10.3324/haematol.2011.050492

Cited by 61 publications

(54 citation statements)

References 59 publications

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“…Although there are no prospective studies, catheter-directed thrombus reduction therapy for extensive, acute UEDVT is technically simple, highly successful, and safe. 4,23,34,37 In patients with an acute CRT, even if the line is removed, anticoagulation is still required and reinsertion of another CVC at a new site is usually needed. There is no evidence that removal of the catheter improves outcomes.…”

Section: Treatment Of Crtmentioning

confidence: 99%

“…Instillation of a thrombolytic agent into the catheter is highly effective in clearing CVC occlusions without causing bleeding. 30,[37][38][39] For example, one or 2 doses of alteplase 2 mg or tenectaplase 2 mg instilled into the occluded catheter with a dwell time of 1-2 hours will relieve 80%-90% of catheter occlusions. [37][38][39] Prevention of CRT Multiple reviews of strategies to try to prevent CRT are available.…”

Section: Management Of Thrombotic Occlusion Of a Cvcmentioning

confidence: 99%

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Central venous catheter–related thrombosis

2014

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Thrombotic complications associated with the use of central venous catheters (CVCs) are common and lead to distressing patient symptoms, catheter dysfunction, increased risk of infections, long-term central venous stenosis, and considerable costs of care. Risk factors for catheter-related thrombosis include use of larger, multilumen, and peripherally inserted catheters in patients with cancer receiving chemotherapy. Symptomatic catheter-related thrombosis is treated with anticoagulation, generally without removing the catheter. The intensity and duration of anticoagulation depend on the extent of thrombosis, risk of bleeding, and need for continued use of a CVC. To date, the clinical benefit of prophylactic doses of anticoagulant has been disappointing and these agents are not used routinely for this purpose. This chapter focuses on recent evidence, remaining controversies, and practical approaches to reducing the burden of thrombosis associated with CVCs. Learning Objectives• To identify the types and consequences of catheter-related thrombotic complications in patients with CVCs • To develop an approach to the management of CVC-related thrombosis • To review the evidence on the prevention of CVC-related thrombosis

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Section: Treatment Of Crtmentioning

confidence: 99%

Section: Management Of Thrombotic Occlusion Of a Cvcmentioning

confidence: 99%

Central venous catheter–related thrombosis

2014

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“…Other thrombolytics require shorter periods of time in the lumen of the vessel to act. 25 In our sample of patients, the obstructions observed in six nonvalved catheters and one proximally valved catheter were adequately treated using urokinase (Taurolock  ), the thrombolytic of choice at our institution.…”

Section: Discussionmentioning

confidence: 98%

“…Baskin et al 25 conducted a study showing that thrombolytic agents successfully eliminate catheter occlusions in the majority of cases, and highlighted the role played by alteplase. Described as a safe and effective medication for deobstructing catheters, the disadvantages of this drug is its elevated cost, the fact that it is less effective than urokinase during the first 30 minutes of infusion, and that it takes more than 4 hours to achieve clearance of the catheter.…”

Section: Discussionmentioning

confidence: 99%

Cateteres venosos centrais de inserção periférica: alternativa ou primeira escolha em acesso vascular?

et al. 2017

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Background: Peripherally inserted central catheters (PICC) are intravenous devices inserted through a superficial or deep vein of an upper or lower extremity and advanced to the distal third of the superior vena cava or proximal third of the inferior vena cava. They offer the advantages of greater safety for infusion of vesicant/irritant and hyperosmolar solutions and enable administration of antibiotics, prolonged parenteral nutrition (PPN), and chemotherapy agents. They also involve reduced risk of infection compared to other vascular catheters and are more cost-effective than centrally inserted venous catheters (CICVC). Objectives: To present the results of our team' s experience with US-guided and fluoroscopy-positioned PICC placement at the Hospital and Maternidade São Luiz (HMSL) Itaim, Rede D' or, Brazil. Methods: This was a prospective, non-randomized study, conducted from February 2015 to November 2016. The institution' s preestablished protocol was followed when vascular access was requested. Indications, prevalent diseases, type of catheter implanted, technical success, and complications related to the catheters were analyzed and inclusion and exclusion criteria are described. Results: A total of 256 vascular accesses were requested, and 236 PICCs (92.1%) and 20 CICVCs (7.9%) were implanted. The main indications were as follows: prolonged antibiotic therapy (52%), PPN (19.3%), and difficult venous access (16%). Technical successes was achieved in 246 catheter placements (96.1%). The right basilic vein was the most common vein punctured for access, in 192 patients (75%), followed by the right brachial vein, in 28 patients (10.9%). Conclusions: Ultrasound-guided and fluoroscopy-positioned PICC placement had a low incidence of complications, reduced infection rates, and proved safe and effective in cases of difficult vascular access. PICCs can be considered the devices of choice for central vascular access.

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“…Tenecteplase has also been shown in Phase III trials to be safe and effective in the treatment of dysfunctional catheters [51,52]. Newer thrombolytic agents such as recombinant-urokinase, afimeprase, and anistreplase are currently under investigation [53].…”

Section: Thrombolytic Therapymentioning

confidence: 99%