Catheter Occlusion PDF

# Catheter Occlusion ## **Prevention** * Use ultrasound (US) guidance for all CVAD insertions and US or other vein visualization technologies for difficult peripheral IV insertions * Proper vessel and catheter selection (choose smallest catheter that meets infusion need and is appropriate for vess...

# Catheter Occlusion ## **Prevention** * Use ultrasound (US) guidance for all CVAD insertions and US or other vein visualization technologies for difficult peripheral IV insertions * Proper vessel and catheter selection (choose smallest catheter that meets infusion need and is appropriate for vessel diameter) * Routine flushing protocols to minimize fibrin accumulation * Avoid restrictive clothing and devices (le., blood pressure cuff) to ipsilateral side * Limit heavy lifting and excessive exercise * Use of engineered stabilization device, and proper dressing management ## **Symptoms** * May be asymptomatic * Inability or difficulty infusing * Leaking at the insertion site * Erythema * Pallor * Pain * Edema * Appearance of collateral veins * Numbness of the extremity, shoulder, neck, or chest * Fibrin can coat the catheter surface and cause partial or total occlusion of vessels * Thrombus may embolize and cause pulmonary embolism or other embolic complication * Post thrombotic syndrome (le., long-term complication of thrombosis resulting in functional disabilities) ## **Treatment** * Catheter removal is not routinely recommended unless accompanied by inability to resolve catheter malfunction, infectious process, progressive symptoms, or anticoagulation therapy is contraindicated * Low-molecular weight heparin (LMWH) or unfractionated heparin, or vitamin K antagonists, may be indicated per physician order # Catheter Occlusion (continued) ## **Causes** * Catheter movement/Inadequate device securement * Mechanical obstruction * Kink in catheter or attached tubing * Primary or secondary tip malposition * Pinch-Off Syndrome [see Catheter or Wire Embolus section for more in-depth discussion) ## **Prevention** * Proactive maintenance * Ensure proper tip location * Routine flushing protocols * Adequate stabilization and proper dressing management ## **Symptoms** * Difficulty or inability to infuse * Sluggish or absent blood return * Forceful flushing of a severely occluded CVAD can lead to catheter breakage. catheter embolus, venous thrombosis, catheter-related bloodstream infections, and other serious complications * Improper use, inadequate maintenance care or lack of early detection and intervention can lead to catheter dysfunction that cannot be resolved by means other than catheter removal # Mechanical Occlusion (continued) ## **Treatment** * Determine type of occlusion/dysfunction * Remove add-on extension sets and change the needleless connector * Remove the dressing and with aseptic technique Inspect the external length of the catheter for any visible kinking * If catheter tip malposition or pinch-off syndrome suspected, chest radiography may be indicated * May require removal/replacement of catheter if unable to resolve dysfunction # Thrombotic Occlusion ## **Causes** * Catheter to vein ratio is too high (CVR), greater than 33% (max of 45%) * Catheter movement/inadequate device securement * Fibrin tail: Accumulation of fibrin from the tip of the catheter. This can attach itself to vein wall * Intraluminal thrombus: Accumulation of clotted blood in the lumen of the catheter ## **Prevention** * Proactive maintenance, early detection, and correction of dysfunction * Ensure proper tip location * Routine flushing protocols * Adequate stabilization and proper dressing management ## **Symptoms** * Difficulty or inability to infuse * Sluggish or absent blood return ## **Treatment** * Rule out tip malposition and mechanical factors prior to instilling a thrombolytic agent (e.g., change needleless connector, check catheter insertion site for kinks in catheter material) * Clearing agent: Alteplase is currently the only FDA cleared thrombolytic agent for the treatment of dysfunctional CVADs. Follow institutional policy for the use of Alteplase for thrombotic occlusions. * The use of Alteplase should be used with caution in the presence of known or suspected bloodstream infection # Thrombotic Occlusion (continued) ## **Treatment, cont.** * Do not flush against resistance. Forceful flushing of a severely occluded CVAD can lead to catheter breakage, catheter embolus, venous thrombosis, catheter-related bloodstream infections, and other serious complications * Improper use, inadequate maintenance, care or lack of early detection and intervention can lead to catheter dysfunction that cannot be resolved by means other than catheter removal # Non-Thrombotic Occlusion ## **Causes** * Precipitation caused by incompatible medications or solutions * Lipid accumulation in the catheter lumen ## **Prevention** * Proactive maintenance and early detection * Routine flushing protocols * Adequate flushing surrounding infusate administration. Use a Push-Pause technique to ensure no residual infusate remains within the catheter. * SAS: Saline, Administer medication Saline * SASH: Saline, Administer medication Saline, Heparin * Use recommended flush agent after medication if saline is incompatible with medication, then follow with saline, and heparin if ordered. ## **Symptoms** * Difficulty or inability infusing or flushing * Sluggish or absent blood return ## **Treatment** * Eliminate other causes of catheter occlusion * A thorough evaluation of the infusates received in the past 24 hours. Consider consulting a pharmacist in determining the cause of the type of precipitate. * Mineral/Acidic Precipitate with low pH (1 - 5) may be treated with hydrochloric acid (HCI) per physician order and institutional policy.