Restoring patency of long-term central venous access devices.

More patients are receiving extended and complex infusion therapies, so there is an increased need for long-term central venous access and the placement of "permanent" central venous access devices (CVADs). CVADs may be necessary for home parenteral nutrition and chronic intravenous antibiotics, chemotherapy, analgesia, and hydration therapies. The use of these catheters for multiple therapies increases the potential for catheter occlusion. Occlusions may be secondary to thrombosis, lipid deposits, or the precipitation of medications or minerals and electrolytes. Various pharmacologic agents have been used to restore patency of occluded CVADs. These agents include thrombolytics, ethyl alcohol, hydrochloric acid, and sodium bicarbonate. A thorough evaluation of the CVAD and the therapies administered via this catheter is necessary to select the most appropriate pharmacologic agent to restore catheter patency.