Management of nonfunctional central venous catheters

Abstract

Management of non-functional central venous catheters traditionally involves instillation of fibrinolytic agents, and if unsuccessful, removal and replacement of the catheter. Many of these catheters, however, are still usable for their original purposes. With time, collateral vessels open, allowing passage of fluids into the circulation. We attempted to preserve such catheters if they were not fractured and were not used for infusing sclerosing agents. In 75 patients, there were 91 occlusive events. Venograms, cathetergrams, or ultrasounds were used to detect the cause of catheter failure, searching for sheath thrombus, subclavian vein or superior vena cava thrombosis. Of the 75 patients, 9 had recurrent failures after original resolution. In 5, the catheter was removed due to sepsis. Therefore the total events available for analysis was 86. The various medical treatments included warfarin, heparin, low molecular weight heparin (LMWH) and fibrinolytics, and passage of time. Overall, 49 events were resolved. For 38 of these 49 events associated signs and symptoms resolved within one week. Thirty-four (34) catheters were removed due to persistent problems, including sepsis in 5. In 22 patients, the catheters remained functional until the patient's death, and in 14 the catheters remained functional until completion of the patient's therapy. Therefore, over half (54%) of the catheters associated with veno-occlusive events can be maintained with these medical approaches. Selective medical management should be applied to non-functioning central venous catheters to avoid added risk, inconvenience, and cost of their replacement.