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Abstract

Introduction: Central venous catheter (CVC) occlusion is the most common CVC complication among pediatric patients and may increase morbidity, disrupt therapy, and necessitate catheter removal Methods: This is a retrospective medical record review of all patients admitted to any intensive care unit at Boston Children's Hospital from March 1, 2011 to December 31, 2012 who received recombinant tissue plasminogen activator (rt-PA), hydrochloric acid, ethanol, and/or sodium bicarbonate for CVC occlusion. Occlusion events were defined by administration of a pharmacologic clearance agent for catheter clearance within at 24-hour period. Restoration of CVC patency was defined as ability to infuse and/or aspirate via CVC. Patient, catheter and treatment characteristics were analyzed. Results: 188 subjects, admitted to one of four critical care units with different unit-based CVC maintenance protocols, experienced a total of 323 CVC occlusion events during the study time period. Administration of a pharmacologic clearance agent restored CVC patency in 224 events (69.3%). Recurrent CVC occlusion occurred in 66 subjects (35.1%). Age less than 4 years (63.7% of occlusion events), exposure to mechanical ventilation (84.2%), narcotic infusion (64.7%), benzodiazepine infusion (67.8%), and CVC size of 4 French or smaller (74.9%) were associated with CVC occlusion. Events were least frequent with the use of continuous heparin infusion for CVC maintenance, (3.4% of occlusion events) as compared to events occurring with the use of intermittent heparin flush maintenance, saline flush, and/or continuous non-heparin containing infusion. Catheter removal occurred in 19 subjects (10.1%). Clinically symptomatic venous thromboembolism (VTE) occurred in 5 subjects in the setting of CVC occlusion (2.6%). Conclusions: CVC occlusion is associated with non-modifiable patient and necessary treatment characteristics. Use of standardized CVC maintenance with continuous heparin containing infusions may decrease morbidity associated with CVC occlusion.