CHAPTER 2


BOX 2.4 Late, Noninfectious Complications Associated With Central Catheters1,5,18


Complication Description


Occlusion (thrombotic, nonthrombotic, or mechanical)


ƒ Inability to aspirate or flush the catheter


ƒ Can occur if blood or precipitates form in the catheter and proper flushing procedures are not used


ƒ Determine cause; consult with pharmacy and health care team


ƒ Catheter salvage is preferred over removal


ƒ Thrombotic: includes intraluminal clot, fibrin sleeve formation, mural thrombus, or thrombosis of a vessel


ƒ Nonthrombotic: causes of intraluminal occlusions may include drug-heparin interactions, inappropriate calcium-phosphate quantities and mixing, or lipid deposits


ƒ Mechanical: risk vs benefit assessment for repair or exchange; catheter embolism can occur with catheter rupture and may result from using too much pressure when flushing the line


Breakage ƒ Requires removal or repair as soon as possible


ƒ Until removal or repair, the catheter must be clamped between where it exits the body and the break to avoid air embolism or leakage of blood


ƒ Patients receiving home parenteral nutrition should be provided a temporary emergency repair kit for use by a home care nurse


Malposition or dislodgement


ƒ All central catheters can dislodge, moving their tip position out of central circulation


ƒ Symptoms include swelling or pain in the neck, shoulder, or chest


ƒ Order a chest x-ray if dislodgement is suspected and to confirm tip location


ƒ The catheter should not be used as a central line until it is repositioned and the tip is confirmed to be in a central location


ƒ Catheter replacement is considered if the tip is in the jugular or contralateral vein or is coiled or looped; most coiled or looped peripherally inserted central catheters are managed by interventional radiology


Box continues 24


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