Clogbusting: time for a concerted approach to catheter occlusions?

Occlusions of central venous catheters in service are frequent, but the random nature of the problem has resulted in a piecemeal approach to solving it. The purpose of this review is to examine what is known from past and recent publications and to recommend strategies for future investigations.

Long-term central venous access is a critical part of nutritional support for many patients with intestinal failure. The technique also has wide applicability in oncology, the management of certain types of infections and in organ failure. The causes of occlusion have been found to be multifactorial, including a combination of mechanical obstruction, chemical precipitation, lipid deposition and thrombus formation. Most unblocking strategies have been aimed at cure rather than prevention, and targeted at individual causes of obstruction. The British Pharmaceutical Nutrition Group and home parenteral nutrition patients group (Patients on Intravenous and Nasogastric Nutrition Therapy), member organizations of the British Association for Parenteral and Enteral Nutrition, have recently charged a subcommittee with targeting future research into a more concerted practical and pharmaceutical approach to the phenomenon.

Catheter occlusion is a common problem costing considerable time and money for patients and healthcare professionals, requiring pro-action rather than reaction. None of the existing approaches is a complete answer, and further, coordinated research effort is needed. Endoluminal brushing is gradually gaining acceptance as a 'catch-all' solution once the catheter malfunctions, but understanding how and why catheters become blocked, and developing strategies to prevent occlusion would be a more scientific approach.