A Prospective Analysis of Central Catheter Occlusions to Direct Guideline Development at Kingston Health Sciences Centre

Abstract

Background: Catheter occlusions are a common central line complication. Depending on the presumed cause (thrombotic or non-thrombotic), recommended management options vary. Although the incidence of nonthrombotic catheter occlusions is reported in the literature to be as high as 42%, alteplase is the only pharmacologic management option available at Kingston Health Sciences Centre (KHSC). At KHSC, the incidence of alteplase failure and the incidence of non-thrombotic catheter occlusions are unknown. Objectives: To assess the incidence of potential non-thrombotic causes of central catheter occlusions at KHSC and determine whether there is a role for adding management options in addition to alteplase to the KHSC Drug Formulary. These findings will also be used to develop KHSC Guidelines for the Management of Occluded Central Catheters. Methods: A prospective chart review of 80 subjects was conducted to assess if alteplase administration restored catheter patency. Daily reports were generated from the Pharmacy Information System to identify patients who were dispensed an alteplase 2 mg vial. The patient’s chart was assessed for documentation in regards to catheter patency restoration post-alteplase administration. The medication administration record was also reviewed for any medications, parenteral nutrition or blood products administered within the previous 24 hours to screen for potential drug incompatibilities or chemical precipitates. Results: The incidence of alteplase failure to resolve central catheter occlusions was 1.25% (1/80). Of the occlusions that resolved, patency was restored in 97.5% (77/79) following a single alteplase 2 mg dose. Nine potential occlusions secondary to drug incompatibilities were identified, however, all resolved with alteplase administration. Conclusion: The incidence of non-thrombotic central catheter occlusions is very low at KHSC and alteplase 2 mg is highly effective in restoring catheter patency. These results indicate that alteplase is being used appropriately, and that there is no need to explore alternative pharmacologic strategies for the management of occluded catheters at KHSC.