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CP-062 Subcutaneously implanted port-chamber central venous catheters: prevention and care of occlusion
  1. M Fleury1,
  2. B Guignard2,
  3. C Fonzo-Christe2,
  4. P Bonnabry1
  1. 1Geneva University Hospitals/School of Pharmaceutical Sciences, Pharmacy/University of Geneva University of Lausanne, Geneva, Switzerland
  2. 2Geneva University Hospitals, Pharmacy, Geneva, Switzerland

Abstract

Background Occlusion of subcutaneously implanted port-chamber central venous access devices (CVAD) is a commonly occurring problem in cancer patient care. A change of port-chamber catheter model in our institution was the opportunity to review nursing care techniques.

Purpose To provide information on nursing care techniques for the prevention and management of thrombotic and non-thrombotic occlusions of subcutaneously implanted port-chamber central venous access devices, so as to contribute to the deliberations of an interdisciplinary working group charged with updating our institution’s best practices, and standardise them across adult and paediatric sectors.

Materials and methods We carried out a structured literature review (Medline/Embase) and a manual search for non-indexed information sources up to February 2013. The keywords used were “central venous catheter”, “peripherally inserted central venous catheter” and “catheter occlusion”. Only publications presenting concrete facts on nursing care were included (drug volumes administered, exact durations of drug delivery, care techniques, written protocols). General recommendations were excluded. The criteria identified were: study methodologies, occlusion prevention techniques, definition and diagnosis, clearance techniques, effectiveness and safety.

Results 26 publications were included: 14 studies (6 prospective, 8 retrospective), 9 review articles, 1 case study series, 1 survey and 1 reference book. Eleven publications concerned adult patients, 9 children and 4 both. Only 6 contained information with all the identified criteria. Fifteen only concerned occlusion prevention techniques, 14 concerned identification of blockages and 22 concerned blockage clearance techniques (17 thrombotic occlusion, 1 non-thrombotic lipid occlusion, 4 for both types). Highlighted points included: minimum 10 ml syringe volume, using NS (normal saline) for flushing and positive pressure filling (pulsed flux technique), thrombotic occlusion treatment using alteplase, the lack of validated, risk free treatment for non-thrombotic occlusion, and cost considerations.

Conclusions Few studies of good methodological quality exist, with wide heterogeneity in types of catheter devices and occlusions evaluated. This renders comparison of preventive practices and occlusion treatment difficult. Literature review revealed a variety of useful insights for the interdisciplinary working group. The costs and risks of occlusion and the repeated use of alteplase call for good quality quantitative and qualitative prospective studies.

No conflict of interest.

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