Developing a protocol to prevent and treat pediatric central venous catheter occlusions

Catheter occlusions are a common occurrence in pediatric patients with central venous catheters. These occlusions are attributable to many factors, such as mechanical problems caused by catheter and patient size, clot formation caused by blood product administration and laboratory sampling, drug precipitation, and lipid residues. Because of the significant patient risk and cost involved in replacing occluded central venous catheters, a multidisciplinary team used a quality improvement approach to determine the effectiveness of urokinase in pediatric patients. Data from the project enabled development of a decision tree for urokinase use. Statistics from the pilot test revealed that 85% of the catheter occlusions were related to thrombotic events, and urokinase was effective in all cases. However, 15% of central line occlusions were related to medication precipitates and were not effectively cleared with urokinase. Given the evidence that urokinase is effective only on fibrin-related occlusions, the decision tree was modified to improve success with occlusions caused by medication precipitates.