Restoring patency to central venous access devices

In September 2006, the Oncology Nursing Advisory Board met to discuss the current management of central venous access device (CVAD) occlusions for patients receiving cancer treatment in centers across Canada. The board found inconsistency in practice across the country and advocated for the development of evidence-based, standardized guidelines for the use of thrombolytic agents to clear thrombotic occlusions. PubMed was searched for articles related to catheter occlusion, catheter patency, and catheter complications published from 1997-2007. The board compared institutional and published protocols for thrombolytic treatment of occluded CVADs, in light of a systematic, evidence-based review of the literature on CVAD-related complications. Restoration of CVAD patency, when appropriate, represents a safe, effective, and costeffective alternative to device replacement and improves patient quality of life. The treatment algorithm presented in this article reflects the board's consensus recommendations for managing thrombotic CVAD occlusions in adult patients with cancer.