Prevention and management of central venous catheter occlusion and thrombosis in children with cancer

Abstract

The views and clinical practice of children's cancer units were surveyed regarding management of central venous catheter (CVC) occlusion (CVC-occlusion), CVC-related thrombosis (CVC-thrombosis) and thromboembolism (CVC-thromboembolism). A questionnaire was sent to all 22 United Kingdom Children's Cancer Study Group centres, requesting information about their views of the importance of, and their practices regarding, prophylaxis, diagnosis and treatment of CVC-occlusion/thrombosis. Twenty (91%) centres responded. Eighty percent, 80% and 70%, respectively, stated that CVC-occlusion, CVC-thrombosis and CVC-thromboembolism were clinically important concerns. All centres used heparinised saline flushes as prophylaxis against CVC-occlusion, with little variation (</=30% centres) in frequency, volume and heparin concentration. Symptoms or signs suggesting partial CVC-occlusion, total CVC-occlusion, or CVC-thrombosis/thromboembolism were always investigated in 20%, 55% and 85% of centres, respectively, but with considerable variability in the nature and sequence of investigations performed, which included (depending on the clinical scenario) chest X-ray, contrast linography or venography, ultrasonography, echocardiography and magnetic resonance venography. A fibrinolytic lock was administered before investigation of CVC-occlusion in 75% of centres. Although 45%, 60% and 80%, respectively, always treated partial CVC-occlusion, total CVC-occlusion or CVC-thrombosis/thromboembolism, the type and order of treatments differed greatly between centres, especially for CVC-thrombosis/thromboembolism, in which CVC removal, systemic anticoagulation (heparin or warfarin), local or systemic fibrinolysis, or thrombectomy were performed in at least some centres. The clinical practice of UKCCSG centres regarding prevention, investigation and treatment of CVC-occlusion/thrombosis varies greatly. Additional trials should facilitate development of evidence-based guidelines.