Management of occlusion and thrombosis associated with long-term indwelling central venous catheters

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

Research output: Contribution to journalReview article

176 Citations (Scopus)

Abstract

Long-term central venous catheters (CVCs) are important instruments in the care of patients with chronic illnesses, but catheter occlusions and catheter-related thromboses are common complications that can result from their use. In this Review, we summarise management of these complications. Mechanical CVC occlusions need cause-specific treatment, whereas thrombotic occlusions usually resolve with thrombolytic treatment, such as alteplase. Prophylaxis with thrombolytic flushes might prevent CVC infections and catheter-related thromboses, but confirmatory studies and cost-effectiveness analysis of this approach are needed. Risk factors for catheter-related thromboses include previous catheter infections, malposition of the catheter tip, and prothrombotic states. Catheter-related thromboses can lead to catheter infection, pulmonary embolism, and post-thrombotic syndrome. Catheter-related thromboses are usually diagnosed by Doppler ultrasonography or venography and treated with anticoagulation therapy for 6 weeks to a year, dependent on the extent of the thrombus, response to initial therapy, and whether thrombophilic factors persist. Prevention of catheter-related thromboses includes proper positioning of the CVC and prevention of infections; anticoagulation prophylaxis is not currently recommended.

Original languageEnglish (US)
Pages (from-to)159-169
Number of pages11
JournalThe Lancet
Volume374
Issue number9684
DOIs
StatePublished - Jul 17 2009

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Indwelling Catheters
Central Venous Catheters
Thrombosis
Catheters
Infection
Catheter-Related Infections
Doppler Ultrasonography
Phlebography
Tissue Plasminogen Activator
Therapeutics
Pulmonary Embolism
Cost-Benefit Analysis
Patient Care
Chronic Disease

All Science Journal Classification (ASJC) codes

  • Medicine(all)

Cite this

Baskin, J. L., Pui, C. H., Reiss, U., Wilimas, J. A., Metzger, M. L., Ribeiro, R. C., & Howard, S. (2009). Management of occlusion and thrombosis associated with long-term indwelling central venous catheters. The Lancet, 374(9684), 159-169. https://doi.org/10.1016/S0140-6736(09)60220-8

Management of occlusion and thrombosis associated with long-term indwelling central venous catheters. / Baskin, Jacquelyn L.; Pui, Ching Hon; Reiss, Ulrike; Wilimas, Judith A.; Metzger, Monika L.; Ribeiro, Raul C.; Howard, Scott.

In: The Lancet, Vol. 374, No. 9684, 17.07.2009, p. 159-169.

Research output: Contribution to journalReview article

Baskin, JL, Pui, CH, Reiss, U, Wilimas, JA, Metzger, ML, Ribeiro, RC & Howard, S 2009, 'Management of occlusion and thrombosis associated with long-term indwelling central venous catheters', The Lancet, vol. 374, no. 9684, pp. 159-169. https://doi.org/10.1016/S0140-6736(09)60220-8
Baskin JL, Pui CH, Reiss U, Wilimas JA, Metzger ML, Ribeiro RC et al. Management of occlusion and thrombosis associated with long-term indwelling central venous catheters. The Lancet. 2009 Jul 17;374(9684):159-169. https://doi.org/10.1016/S0140-6736(09)60220-8
Baskin, Jacquelyn L. ; Pui, Ching Hon ; Reiss, Ulrike ; Wilimas, Judith A. ; Metzger, Monika L. ; Ribeiro, Raul C. ; Howard, Scott. / Management of occlusion and thrombosis associated with long-term indwelling central venous catheters. In: The Lancet. 2009 ; Vol. 374, No. 9684. pp. 159-169.
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