Evaluation of 6 years use of sodium hydroxide solution to clear partially occluded central venous catheters

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• 作者：Suzanne G. Bader ; Petra Balke ; Cora F. Jonkers-Schuitema ; Tirzah A.J. Tas ; Hans P. Sauerwein
• 关键词：Occlusion of central venous catheter ; Sodium hydroxide ; Fat emulsion ; Calcium carbonate ; Home parenteral nutrition
• 刊名：Clinical Nutrition
• 出版年：2007
• 出版时间：February 2007
• 年：2007
• 卷：26
• 期：1
• 页码：141-144
• 全文大小：184 K

文摘

Central venous catheter occlusion is a frequently occurring complication during home parenteral nutrition (HPN). The aim of the study was to investigate the effectiveness of sodium hydroxide (NaOH) administration to clear an occluded central venous catheter especially in HPN.

Method

Retrospective study to the use of NaOH in partially occluded central venous catheters. About 45 patients with HPN treated in the Academic Medical Center of the University of Amsterdam (AMC) were included in this study between January 1997 and April 2003. Excluded from the study were patients under the age of 18 at the start of HPN and/or patients who use parenteral nutrition for less than 3 months. Partial catheter occlusion was defined as a spontaneous flow less than 60 drops/min.

Results

In total, 130 occlusions were registered in 29 HPN patients. The other 16 HPN patients did not report any occlusion. The incidence of occlusions in fat containing total parenteral nutrition (TPN) was 1 occlusion in 167 feeding days. TPN without fat showed only one occlusion (incidence 1 in 7126 feeding days). The use of a lipid emulsion proved an important risk factor for catheter occlusion in this study (coration:none; color:black"" href=""/science?_ob=MathURL&_method=retrieve&_udi=B6WCM-4M9H3CS-1&_mathId=mml1&_user=3986987&_cdi=6742&_rdoc=21&_acct=C000050221&_version=1&_userid=10&md5=338406ea7db28adcbdc79221b6850b76"" title=""Click to view the MathML source"">P<0.05, RR=43).

Ninety-five central venous catheter occlusions were treated with NaOH 0.1 M. The remaining occlusions were total or mechanical occlusions making NaOH treatment impossible. In 73 out of 95 partial occlusions treatment with NaOH was effective coration:none; color:black"" href=""/science?_ob=MathURL&_method=retrieve&_udi=B6WCM-4M9H3CS-1&_mathId=mml2&_user=3986987&_cdi=6742&_rdoc=21&_acct=C000050221&_version=1&_userid=10&md5=c62c31f997002b3583d1ee0a470ab69e"" title=""Click to view the MathML source"">(P<0.05). Using NaOH extended the use of 32 catheters (range 7–1592 days, mean 328). Twenty-one out of 32 catheters could be used for more than 3 months after using NaOH coration:none; color:black"" href=""/science?_ob=MathURL&_method=retrieve&_udi=B6WCM-4M9H3CS-1&_mathId=mml3&_user=3986987&_cdi=6742&_rdoc=21&_acct=C000050221&_version=1&_userid=10&md5=ed6827f9d08fc4924c653bc150f95c32"" title=""Click to view the MathML source"">(P<0.05).

Conclusion

We conclude that perfusion of a partial occluded central venous catheter (defined as 25–60 drops/min) used for parenteral nutrition with 0.1 N NaOH is safe and shows a significant long term improvement in catheter care, by preventing total occlusion and operative removal.