Prevention and management of PICC occlusion in adults: an expert consensus_Chinese Journal of Evidence-Based Medicine

Authors：

 Chinese Anti-Cancer Association Oncologic Nursing Committee; Evidence-based Nursing Center ,  West China Hospital, Sichuan University; Cancer Center , West China Hospital, Sichuan University

Corresponding?author：

Chinese Anti-Cancer Association Oncologic Nursing Committee; Evidence-based Nursing Center, Email: jiangkunyan@163.com; West China Hospital, Sichuan University; Cancer Center, Email: lijunying3535@163.com

Keywords：

Peripherally inserted central catheter; Catheter occlusion; Expert consensus; Nursing care

DOI：

10.7507/1672-2531.202311143

Video：

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Abstract Full text Figures/Tables Video References Cited by

Peripherally inserted central catheter (PICC) is widely used as an intravenous therapy pathway, and catheter occlusion is one of the most common complications during the use of PICC. Catheter occlusion may lead to extubation or re-catheterization, which may generate prolonged hospital stay and increased medical costs, thus affecting the implementation of treatment and patient prognosis. The prevention and treatment of occlusion are of great significance. Daily maintenance and nursing operations should be complete, standardized and implemented in place. Evidence-based standard procedures should be established to meet the needs of clinical work. This consensus follows the methods and principles provided in the WHO guidelines formulation manual, and forms a systematic and standardized clinical practice process, including PICC patency assessment, catheter occlusion degree and type assessment, risk factor prevention, blockage management, etc. The purpose of this consensus is to reduce catheter-related complications, ensure the longevity of PICC and the safety of patient treatment.

Citation： Chinese Anti-Cancer Association Oncologic Nursing Committee; Evidence-based Nursing Center, West China Hospital, Sichuan University; Cancer Center, West China Hospital, Sichuan University. Prevention and management of PICC occlusion in adults: an expert consensus. Chinese Journal of Evidence-Based Medicine, 2024, 24(3): 249-257. doi: 10.7507/1672-2531.202311143 Copy

1.	Canadian Vascular Access Association. Occlusion management guideline for central venous access devices (CVADs). Dundas: Andrew John Publishing Inc, 2019.
2.	Gorski LA, Hadaway L, Hagle ME, et al. Infusion therapy standards of practice (8th edition). J Infus Nurs, 2021, 44(1S): S1-S224.
3.	Canadian Vascular Access Association. Canadian vascular access and infusion therapy guidelines. Pembroke: Pappin Communications, 2019.
4.	Santos EJ, Nunes MM, Cardoso DF, et al. Effectiveness of heparin versus 0.9% saline solution in maintaining the permeability of central venous catheters: a systematic review. Rev Esc Enferm USP, 2015, 49(6): 999-1007.
5.	Gorski LA. The 2016 infusion therapy standards of practice. Home Healthc Now, 2017, 35(1): 10-18.
6.	Rykov MY, Zaborovskij SV, Shvecov AN, et al. Peripherally inserted central catheters in the treatment of children with cancer: results of a multicenter study. J Vasc Access, 2018, 19(4): 378-381.
7.	范本芳, 翁衛群, 王煦, 等. 運用醫療失效模式與效應分析降低PICC堵管發生率. 護理學雜志, 2017, 32(18): 68-70.
8.	Kumwenda M, Dougherty L, Spooner H, et al. Managing dysfunctional central venous access devices: a practical approach to urokinase thrombolysis. Br J Nurs, 2018, 27(2): S4-S10.
9.	中華護理學會靜脈輸液治療專業委員會. 臨床靜脈導管維護操作專家共識. 中華護理雜志, 2019, 54(9): 1334-1342.
10.	金琳, 許陽子, 牛麗卿, 等. 根本原因分析法在腫瘤患者PICC非計劃拔管中的應用. 護理學報, 2012, 19(21): 33-35.
11.	Pan M, Meng A, Yin R, et al. Nursing interventions to reduce peripherally inserted central catheter occlusion for cancer patients: a systematic review of literature. Cancer Nurs, 2019, 42(6): E49-E58.
12.	Dougherty L. Peripherally inserted central venous catheters: frequency, diagnosis, and management of occlusive and mechanical PICC complications. Milano: Springer, 2014: 85-94.
13.	Goossens GA. Flushing and locking of venous catheters: available evidence and evidence deficit. Nurs Res Pract, 2015, 2015: 985686.
14.	Ast D, Ast T. Nonthrombotic complications related to central vascular access devices. J Infus Nurs, 2014, 37(5): 349-358.
15.	Linnemann B. Management of complications related to central venous catheters in cancer patients: an update. Semin Thromb Hemost, 2014, 40(3): 382-394.
16.	Gorski LA. Phillips’s manual of I. V. therapeutics: evidence-based practice for infusion therapy (7th edition). Philadelphia: F A Davis Company, 2018.
17.	Geerts W. Central venous catheter-related thrombosis. Hematology Am Soc Hematol Educ Program, 2014, 2014(1): 306-311.
18.	Niyyar VD, Chan MR. Interventional nephrology: catheter dysfunction--prevention and troubleshooting. Clin J Am Soc Nephrol, 2013, 8(7): 1234-1243.
19.	Wall C, Moore J, Thachil J. Catheter-related thrombosis: a practical approach. J Intensive Care Soc, 2016, 17(2): 160-167.
20.	Stammers D, Connolly B, Brand?o LR, et al. Evaluation of the need for chest X-rays in the management of asymptomatic, intraluminal vascular access device occlusion in childhood cancer. Pediatr Blood Cancer, 2017, 64(7): e26378.
21.	Zheng LY, Xue H, Yuan H, et al. Efficacy of management for obstruction caused by precipitated medication or lipids in central venous access devices: a systematic review and meta-analysis. J Vasc Access, 2019, 20(6): 583-591.
22.	Royal College of Nursing. Standards for infusion therapy (4th edition). London: Royal College of Nursing, 2018.
23.	Gorski LA. Phillips’s Manual of I. V. therapeutics: evidence-based practice for infusion therapy (6th edition). Philadelphia: F A Davis Company, 2016.
24.	Schiffer CA, Mangu PB, Wade JC, et al. Central venous catheter care for the patient with cancer: American Society of Clinical Oncology clinical practice guideline. J Clin Oncol, 2013, 31(10): 1357-1370.
25.	王文雅, 謝士芳. PICC非血栓性堵管相關原因及其應對策略的研究進展. 全科護理, 2020, 18(34): 4742-4744.
26.	中華護理學會靜脈輸液治療專業委員會. 靜脈導管常見并發癥臨床護理實踐指南. 中華現代護理雜志, 2022, 28(18): 2381-2395.
27.	國家衛生和計劃生育委員會. 靜脈治療護理技術操作規范. 2014.
28.	曹文娟, 王玨嵐, 李采虹, 等. 老年患者經外周靜脈置入中心靜脈導管相關性血栓形成的危險因素研究進展. 實用醫院臨床雜志, 2021, 18(5): 209-212.
29.	Gentile A, Petit L, Masson F, et al. Subclavian central venous catheter-related thrombosis in trauma patients: incidence, risk factors and influence of polyurethane type. Crit Care, 2013, 17(3): R103.
30.	Sharp R, Cummings M, Fielder A, et al. The catheter to vein ratio and rates of symptomatic venous thromboembolism in patients with a peripherally inserted central catheter (PICC): a prospective cohort study. Int J Nurs Stud, 2015, 52(3): 677-685.
31.	Waterhouse J, Bandisode V, Brandon D, et al. Evaluation of the use of a stabilization device to improve the quality of care in patients with peripherally inserted central catheters. AACN Adv Crit Care, 2014, 25(3): 213-220.
32.	Barton A. Keeping up to date with catheter securement: an overview. Br J Nurs, 2016, 25(14): S5-S6.
33.	Rickard C, Ullman A, Kleidon T, et al. Ten tips for dressing and securement of IV device wounds. Aust Nurs Midwifery J, 2017, 24(10): 32-34.
34.	Ullman AJ, Cooke ML, Mitchell M, et al. Dressing and securement for central venous access devices (CVADs): a Cochrane systematic review. Int J Nurs Stud, 2016, 59: 177-196.
35.	Mitchell ML, Ullman AJ, Takashima M, et al. Central venous access device securement and dressing effectiveness: the CASCADE pilot randomised controlled trial in the adult intensive care. Aust Crit Care, 2020, 33(5): 441-451.
36.	Marsh N, Webster J, Mihala G, et al. Devices and dressings to secure peripheral venous catheters: a Cochrane systematic review and meta-analysis. Int J Nurs Stud, 2017, 67: 12-19.
37.	Corley A, Marsh N, Ullman AJ, et al. Tissue adhesive for vascular access devices: who, what, where and when. Br J Nurs, 2017, 26(19): S4-S17.
38.	Hitchcock J, Savine L. Medical adhesive-related skin injuries associated with vascular access. Br J Nurs, 2017, 26(8): S4-S12.
39.	Kleidon TM, Rickard CM, Gibson V, et al. Smile - secure my intravenous line effectively: a pilot randomised controlled trial of peripheral intravenous catheter securement in paediatrics. J Tissue Viability, 2020, 29(2): 82-90.
40.	Corley A, Ullman AJ, Mihala G, et al. Peripheral intravenous catheter dressing and securement practice is associated with site complications and suboptimal dressing integrity: a secondary analysis of 40, 637 catheters. Int J Nurs Stud, 2019, 100: 103409.
41.	Moon HM, Kim S, Yun KW, et al. Clinical characteristics and risk factors of long-term central venous catheter-associated bloodstream infections in children. Pediatr Infect Dis J, 2018, 37(5): 401-406.
42.	Alexander M, Alsbrooks K, Andreica I. ISMP safe practice guidelines for adult IV push medications. Institute for Safe Medication Practices website, 2015.
43.	Keogh S, Flynn J, Marsh N, et al. Varied flushing frequency and volume to prevent peripheral intravenous catheter failure: a pilot, factorial randomised controlled trial in adult medical-surgical hospital patients. Trials, 2016, 17(1): 348.
44.	Schreiber S, Zanchi C, Ronfani L, et al. Normal saline flushes performed once daily maintain peripheral intravenous catheter patency: a randomised controlled trial. Arch Dis Child, 2015, 100(7): 700-703.
45.	Chapla K, Oza-Gajera BP, Yevzlin AS, et al. Hemodialysis catheter locking solutions and the prevention of catheter dysfunction: a meta-analysis. J Vasc Access, 2015, 16(2): 107-112.
46.	Heidari Gorji MA, Rezaei F, Jafari H, et al. Comparison of the effects of heparin and 0. 9% sodium chloride solutions in maintenance of patency of central venous catheters. Anesth Pain Med, 2015, 5(2): e22595.
47.	Debourdeau P, Farge D, Beckers M, et al. International clinical practice guidelines for the treatment and prophylaxis of thrombosis associated with central venous catheters in patients with cancer. J Thromb Haemost, 2013, 11(1): 71-80.
48.	Pittiruti M, Bertoglio S, Scoppettuolo G, et al. Evidence-based criteria for the choice and the clinical use of the most appropriate lock solutions for central venous catheters (excluding dialysis catheters): a GAVeCeLT consensus. J Vasc Access, 2016, 17(6): 453-464.
49.	Pittiruti M, Emoli A, Porta P, et al. A prospective, randomized comparison of three different types of valved and non-valved peripherally inserted central catheters. J Vasc Access, 2014, 15(6): 519-523.
50.	中心靜脈導管沖管及封管共識專家組. 中心靜脈導管沖管及封管專家共識. 中華急診醫學雜志, 2022, 31(4): 442-447.
51.	Seneviratne CJ, Yip JW, Chang JW, et al. Effect of culture media and nutrients on biofilm growth kinetics of laboratory and clinical strains of Enterococcus faecalis. Arch Oral Biol, 2013, 58(10): 1327-1334.
52.	US Food and Drug Administration. Sterile water for injection. 2014.
53.	江南. 兩種封管液在預防PICC堵管中的應用與效果研究. 杭州: 浙江大學, 2018.
54.	中心靜脈血管通路裝置安全管理專家組. 中心靜脈血管通路裝置安全管理專家共識(2019版). 中華外科雜志, 2020, 58(4): 261-272.
55.	張愛華, 李曉芳. 高凝狀態患者各類中心靜脈導管完全血凝性堵塞的原因分析及防范對策. 貴州醫藥, 2018, 42(12): 1536.
56.	Zacharioudakis IM, Zervou FN, Arvanitis M, et al. Antimicrobial lock solutions as a method to prevent central line-associated bloodstream infections: a meta-analysis of randomized controlled trials. Clin Infect Dis, 2014, 59(12): 1741-1749.
57.	王東旭, 張艷, 孫建華, 等. 預充式導管沖洗器對預防中心靜脈導管相關性血流感染的系統綜述. 護理研究, 2019, 33(21): 3685-3691.
58.	石蕓, 鄭亞萍, 酈艷, 等. 單手雙腔同時封管在預防PICC堵管中的應用. 中華護理雜志, 2017, 52(5): 621-623.
59.	Lenz JR, Degnan DD, Hertig JB, et al. A review of best practices for intravenous push medication administration. J Infus Nurs, 2017, 40(6): 354-358.
60.	Steadman E, Raisch DW, Bennett CL, et al. Evaluation of a potential clinical interaction between ceftriaxone and calcium. Antimicrob Agents Chemother, 2010, 54(4): 1534-1540.
61.	Ullman AJ, Condon P, Edwards R, et al. Prevention of occlusion of cEnTral lInes for children with cancer: an implementation study. J Paediatr Child Health, 2020, 56(12): 1875-1884.
62.	Spencer TR. Repositioning of central venous access devices using a high-flow flush technique - a clinical practice and cost review. J Vasc Access, 2017, 18(5): 419-425.
63.	Hitchcock J. Preventing intraluminal occlusion in peripherally inserted central catheters. Br J Nurs, 2016, 25(19): S12-S18.
64.	Kennard AL, Walters GD, Jiang SH, et al. Interventions for treating central venous haemodialysis catheter malfunction. Cochrane Database Syst Rev, 2017, (10): CD011953.
65.	Scott DM, Ling CY, MacQueen BC, et al. Recombinant tissue plasminogen activator to restore catheter patency: efficacy and safety analysis from a multihospital NICU system. J Perinatol, 2017, 37(3): 291-295.
66.	Jafari N, Seidl E, Dancsecs K. Evaluation of alteplase 1 mg for the restoration of occluded central venous access devices in a tertiary care hospital. J Assoc Vas Access, 2018, 23(1): 51-55.
67.	Mendes ML, Castro JH, Silva TN, et al. Effective use of alteplase for occluded tunneled venous catheter in hemodialysis patients. Artif Organs, 2014, 38(5): 399-403.
68.	Ponce D, Mendes M, Silva T, et al. Occluded tunneled venous catheter in hemodialysis patients: risk factors and efficacy of alteplase. Artif Organs, 2015, 39(9): 741-747.
69.	Anderson DM, Pesaturo KA, Casavant J, et al. Alteplase for the treatment of catheter occlusion in pediatric patients. Ann Pharmacother, 2013, 47(3): 405-409.
70.	Duerksen C. Unblocked: introducing alteplase to community care. Vasc Access, 2016, 10(3): 15-21.
71.	Pollo V, Dionízio D, Bucuvic EM, et al. Alteplase vs. urokinase for occluded hemodialysis catheter: a randomized trial. Hemodial Int, 2016, 20(3): 378-384.
72.	Kumwenda MJ, Mitra S, Khawaja A, et al. Prospective audit to study urokinase use to restore patency in occluded central venous catheters (Passport 1). J Vasc Access, 2019, 20(6): 752-759.
73.	國際血管聯盟中國分會, 中國老年醫學學會周圍血管疾病管理分會. 輸液導管相關靜脈血栓形成防治中國專家共識(2020版). 中國實用外科雜志, 2020, 40(4): 377-383.
74.	Massmann A, Jagoda P, Kranzhoefer N, et al. Local low-dose thrombolysis for safe and effective treatment of venous port-catheter thrombosis. Ann Surg Oncol, 2015, 22(5): 1593-1597.
75.	Baskin JL, Reiss U, Wilimas JA, et al. Thrombolytic therapy for central venous catheter occlusion. Haematologica, 2012, 97(5): 641-650.
76.	Westergaard B, Classen V, Walther-Larsen S. Peripherally inserted central catheters in infants and children - indications, techniques, complications and clinical recommendations. Acta Anaesthesiol Scand, 2013, 57(3): 278-287.
77.	Bolton D. Preventing occlusion and restoring patency to central venous catheters. Br J Community Nurs, 2013, 18(11): 539-540.
78.	Giordano P, Saracco P, Grassi M, et al. Recommendations for the use of long-term central venous catheter (CVC) in children with hemato-oncological disorders: management of CVC-related occlusion and CVC-related thrombosis. Ann Hematol, 2015, 94(11): 1765-1776.
79.	Rowan CM, Miller KE, Beardsley AL, et al. Alteplase use for malfunctioning central venous catheters correlates with catheter-associated bloodstream infections. Pediatr Crit Care Med, 2013, 14(3): 306-309.
80.	Thakarar K, Collins M, Kwong L, et al. The role of tissue plasminogen activator use and systemic hypercoagulability in central line-associated bloodstream infections. Am J Infect Control, 2014, 42(4): 417-420.
81.	Pai VB, Plogsted S. Efficacy and safety of using L-cysteine as a catheter-clearing agent for nonthrombotic occlusions of central venous catheters in children. Nutr Clin Pract, 2014, 29(5): 636-638.

1. Canadian Vascular Access Association. Occlusion management guideline for central venous access devices (CVADs). Dundas: Andrew John Publishing Inc, 2019.
2. Gorski LA, Hadaway L, Hagle ME, et al. Infusion therapy standards of practice (8th edition). J Infus Nurs, 2021, 44(1S): S1-S224.
3. Canadian Vascular Access Association. Canadian vascular access and infusion therapy guidelines. Pembroke: Pappin Communications, 2019.
4. Santos EJ, Nunes MM, Cardoso DF, et al. Effectiveness of heparin versus 0.9% saline solution in maintaining the permeability of central venous catheters: a systematic review. Rev Esc Enferm USP, 2015, 49(6): 999-1007.
5. Gorski LA. The 2016 infusion therapy standards of practice. Home Healthc Now, 2017, 35(1): 10-18.
6. Rykov MY, Zaborovskij SV, Shvecov AN, et al. Peripherally inserted central catheters in the treatment of children with cancer: results of a multicenter study. J Vasc Access, 2018, 19(4): 378-381.
7. 范本芳, 翁衛群, 王煦, 等. 運用醫療失效模式與效應分析降低PICC堵管發生率. 護理學雜志, 2017, 32(18): 68-70.
8. Kumwenda M, Dougherty L, Spooner H, et al. Managing dysfunctional central venous access devices: a practical approach to urokinase thrombolysis. Br J Nurs, 2018, 27(2): S4-S10.
9. 中華護理學會靜脈輸液治療專業委員會. 臨床靜脈導管維護操作專家共識. 中華護理雜志, 2019, 54(9): 1334-1342.
10. 金琳, 許陽子, 牛麗卿, 等. 根本原因分析法在腫瘤患者PICC非計劃拔管中的應用. 護理學報, 2012, 19(21): 33-35.
11. Pan M, Meng A, Yin R, et al. Nursing interventions to reduce peripherally inserted central catheter occlusion for cancer patients: a systematic review of literature. Cancer Nurs, 2019, 42(6): E49-E58.
12. Dougherty L. Peripherally inserted central venous catheters: frequency, diagnosis, and management of occlusive and mechanical PICC complications. Milano: Springer, 2014: 85-94.
13. Goossens GA. Flushing and locking of venous catheters: available evidence and evidence deficit. Nurs Res Pract, 2015, 2015: 985686.
14. Ast D, Ast T. Nonthrombotic complications related to central vascular access devices. J Infus Nurs, 2014, 37(5): 349-358.
15. Linnemann B. Management of complications related to central venous catheters in cancer patients: an update. Semin Thromb Hemost, 2014, 40(3): 382-394.
16. Gorski LA. Phillips’s manual of I. V. therapeutics: evidence-based practice for infusion therapy (7th edition). Philadelphia: F A Davis Company, 2018.
17. Geerts W. Central venous catheter-related thrombosis. Hematology Am Soc Hematol Educ Program, 2014, 2014(1): 306-311.
18. Niyyar VD, Chan MR. Interventional nephrology: catheter dysfunction--prevention and troubleshooting. Clin J Am Soc Nephrol, 2013, 8(7): 1234-1243.
19. Wall C, Moore J, Thachil J. Catheter-related thrombosis: a practical approach. J Intensive Care Soc, 2016, 17(2): 160-167.
20. Stammers D, Connolly B, Brand?o LR, et al. Evaluation of the need for chest X-rays in the management of asymptomatic, intraluminal vascular access device occlusion in childhood cancer. Pediatr Blood Cancer, 2017, 64(7): e26378.
21. Zheng LY, Xue H, Yuan H, et al. Efficacy of management for obstruction caused by precipitated medication or lipids in central venous access devices: a systematic review and meta-analysis. J Vasc Access, 2019, 20(6): 583-591.
22. Royal College of Nursing. Standards for infusion therapy (4th edition). London: Royal College of Nursing, 2018.
23. Gorski LA. Phillips’s Manual of I. V. therapeutics: evidence-based practice for infusion therapy (6th edition). Philadelphia: F A Davis Company, 2016.
24. Schiffer CA, Mangu PB, Wade JC, et al. Central venous catheter care for the patient with cancer: American Society of Clinical Oncology clinical practice guideline. J Clin Oncol, 2013, 31(10): 1357-1370.
25. 王文雅, 謝士芳. PICC非血栓性堵管相關原因及其應對策略的研究進展. 全科護理, 2020, 18(34): 4742-4744.
26. 中華護理學會靜脈輸液治療專業委員會. 靜脈導管常見并發癥臨床護理實踐指南. 中華現代護理雜志, 2022, 28(18): 2381-2395.
27. 國家衛生和計劃生育委員會. 靜脈治療護理技術操作規范. 2014.
28. 曹文娟, 王玨嵐, 李采虹, 等. 老年患者經外周靜脈置入中心靜脈導管相關性血栓形成的危險因素研究進展. 實用醫院臨床雜志, 2021, 18(5): 209-212.
29. Gentile A, Petit L, Masson F, et al. Subclavian central venous catheter-related thrombosis in trauma patients: incidence, risk factors and influence of polyurethane type. Crit Care, 2013, 17(3): R103.
30. Sharp R, Cummings M, Fielder A, et al. The catheter to vein ratio and rates of symptomatic venous thromboembolism in patients with a peripherally inserted central catheter (PICC): a prospective cohort study. Int J Nurs Stud, 2015, 52(3): 677-685.
31. Waterhouse J, Bandisode V, Brandon D, et al. Evaluation of the use of a stabilization device to improve the quality of care in patients with peripherally inserted central catheters. AACN Adv Crit Care, 2014, 25(3): 213-220.
32. Barton A. Keeping up to date with catheter securement: an overview. Br J Nurs, 2016, 25(14): S5-S6.
33. Rickard C, Ullman A, Kleidon T, et al. Ten tips for dressing and securement of IV device wounds. Aust Nurs Midwifery J, 2017, 24(10): 32-34.
34. Ullman AJ, Cooke ML, Mitchell M, et al. Dressing and securement for central venous access devices (CVADs): a Cochrane systematic review. Int J Nurs Stud, 2016, 59: 177-196.
35. Mitchell ML, Ullman AJ, Takashima M, et al. Central venous access device securement and dressing effectiveness: the CASCADE pilot randomised controlled trial in the adult intensive care. Aust Crit Care, 2020, 33(5): 441-451.
36. Marsh N, Webster J, Mihala G, et al. Devices and dressings to secure peripheral venous catheters: a Cochrane systematic review and meta-analysis. Int J Nurs Stud, 2017, 67: 12-19.
37. Corley A, Marsh N, Ullman AJ, et al. Tissue adhesive for vascular access devices: who, what, where and when. Br J Nurs, 2017, 26(19): S4-S17.
38. Hitchcock J, Savine L. Medical adhesive-related skin injuries associated with vascular access. Br J Nurs, 2017, 26(8): S4-S12.
39. Kleidon TM, Rickard CM, Gibson V, et al. Smile - secure my intravenous line effectively: a pilot randomised controlled trial of peripheral intravenous catheter securement in paediatrics. J Tissue Viability, 2020, 29(2): 82-90.
40. Corley A, Ullman AJ, Mihala G, et al. Peripheral intravenous catheter dressing and securement practice is associated with site complications and suboptimal dressing integrity: a secondary analysis of 40, 637 catheters. Int J Nurs Stud, 2019, 100: 103409.
41. Moon HM, Kim S, Yun KW, et al. Clinical characteristics and risk factors of long-term central venous catheter-associated bloodstream infections in children. Pediatr Infect Dis J, 2018, 37(5): 401-406.
42. Alexander M, Alsbrooks K, Andreica I. ISMP safe practice guidelines for adult IV push medications. Institute for Safe Medication Practices website, 2015.
43. Keogh S, Flynn J, Marsh N, et al. Varied flushing frequency and volume to prevent peripheral intravenous catheter failure: a pilot, factorial randomised controlled trial in adult medical-surgical hospital patients. Trials, 2016, 17(1): 348.
44. Schreiber S, Zanchi C, Ronfani L, et al. Normal saline flushes performed once daily maintain peripheral intravenous catheter patency: a randomised controlled trial. Arch Dis Child, 2015, 100(7): 700-703.
45. Chapla K, Oza-Gajera BP, Yevzlin AS, et al. Hemodialysis catheter locking solutions and the prevention of catheter dysfunction: a meta-analysis. J Vasc Access, 2015, 16(2): 107-112.
46. Heidari Gorji MA, Rezaei F, Jafari H, et al. Comparison of the effects of heparin and 0. 9% sodium chloride solutions in maintenance of patency of central venous catheters. Anesth Pain Med, 2015, 5(2): e22595.
47. Debourdeau P, Farge D, Beckers M, et al. International clinical practice guidelines for the treatment and prophylaxis of thrombosis associated with central venous catheters in patients with cancer. J Thromb Haemost, 2013, 11(1): 71-80.
48. Pittiruti M, Bertoglio S, Scoppettuolo G, et al. Evidence-based criteria for the choice and the clinical use of the most appropriate lock solutions for central venous catheters (excluding dialysis catheters): a GAVeCeLT consensus. J Vasc Access, 2016, 17(6): 453-464.
49. Pittiruti M, Emoli A, Porta P, et al. A prospective, randomized comparison of three different types of valved and non-valved peripherally inserted central catheters. J Vasc Access, 2014, 15(6): 519-523.
50. 中心靜脈導管沖管及封管共識專家組. 中心靜脈導管沖管及封管專家共識. 中華急診醫學雜志, 2022, 31(4): 442-447.
51. Seneviratne CJ, Yip JW, Chang JW, et al. Effect of culture media and nutrients on biofilm growth kinetics of laboratory and clinical strains of Enterococcus faecalis. Arch Oral Biol, 2013, 58(10): 1327-1334.
52. US Food and Drug Administration. Sterile water for injection. 2014.
53. 江南. 兩種封管液在預防PICC堵管中的應用與效果研究. 杭州: 浙江大學, 2018.
54. 中心靜脈血管通路裝置安全管理專家組. 中心靜脈血管通路裝置安全管理專家共識(2019版). 中華外科雜志, 2020, 58(4): 261-272.
55. 張愛華, 李曉芳. 高凝狀態患者各類中心靜脈導管完全血凝性堵塞的原因分析及防范對策. 貴州醫藥, 2018, 42(12): 1536.
56. Zacharioudakis IM, Zervou FN, Arvanitis M, et al. Antimicrobial lock solutions as a method to prevent central line-associated bloodstream infections: a meta-analysis of randomized controlled trials. Clin Infect Dis, 2014, 59(12): 1741-1749.
57. 王東旭, 張艷, 孫建華, 等. 預充式導管沖洗器對預防中心靜脈導管相關性血流感染的系統綜述. 護理研究, 2019, 33(21): 3685-3691.
58. 石蕓, 鄭亞萍, 酈艷, 等. 單手雙腔同時封管在預防PICC堵管中的應用. 中華護理雜志, 2017, 52(5): 621-623.
59. Lenz JR, Degnan DD, Hertig JB, et al. A review of best practices for intravenous push medication administration. J Infus Nurs, 2017, 40(6): 354-358.
60. Steadman E, Raisch DW, Bennett CL, et al. Evaluation of a potential clinical interaction between ceftriaxone and calcium. Antimicrob Agents Chemother, 2010, 54(4): 1534-1540.
61. Ullman AJ, Condon P, Edwards R, et al. Prevention of occlusion of cEnTral lInes for children with cancer: an implementation study. J Paediatr Child Health, 2020, 56(12): 1875-1884.
62. Spencer TR. Repositioning of central venous access devices using a high-flow flush technique - a clinical practice and cost review. J Vasc Access, 2017, 18(5): 419-425.
63. Hitchcock J. Preventing intraluminal occlusion in peripherally inserted central catheters. Br J Nurs, 2016, 25(19): S12-S18.
64. Kennard AL, Walters GD, Jiang SH, et al. Interventions for treating central venous haemodialysis catheter malfunction. Cochrane Database Syst Rev, 2017, (10): CD011953.
65. Scott DM, Ling CY, MacQueen BC, et al. Recombinant tissue plasminogen activator to restore catheter patency: efficacy and safety analysis from a multihospital NICU system. J Perinatol, 2017, 37(3): 291-295.
66. Jafari N, Seidl E, Dancsecs K. Evaluation of alteplase 1 mg for the restoration of occluded central venous access devices in a tertiary care hospital. J Assoc Vas Access, 2018, 23(1): 51-55.
67. Mendes ML, Castro JH, Silva TN, et al. Effective use of alteplase for occluded tunneled venous catheter in hemodialysis patients. Artif Organs, 2014, 38(5): 399-403.
68. Ponce D, Mendes M, Silva T, et al. Occluded tunneled venous catheter in hemodialysis patients: risk factors and efficacy of alteplase. Artif Organs, 2015, 39(9): 741-747.
69. Anderson DM, Pesaturo KA, Casavant J, et al. Alteplase for the treatment of catheter occlusion in pediatric patients. Ann Pharmacother, 2013, 47(3): 405-409.
70. Duerksen C. Unblocked: introducing alteplase to community care. Vasc Access, 2016, 10(3): 15-21.
71. Pollo V, Dionízio D, Bucuvic EM, et al. Alteplase vs. urokinase for occluded hemodialysis catheter: a randomized trial. Hemodial Int, 2016, 20(3): 378-384.
72. Kumwenda MJ, Mitra S, Khawaja A, et al. Prospective audit to study urokinase use to restore patency in occluded central venous catheters (Passport 1). J Vasc Access, 2019, 20(6): 752-759.
73. 國際血管聯盟中國分會, 中國老年醫學學會周圍血管疾病管理分會. 輸液導管相關靜脈血栓形成防治中國專家共識(2020版). 中國實用外科雜志, 2020, 40(4): 377-383.
74. Massmann A, Jagoda P, Kranzhoefer N, et al. Local low-dose thrombolysis for safe and effective treatment of venous port-catheter thrombosis. Ann Surg Oncol, 2015, 22(5): 1593-1597.
75. Baskin JL, Reiss U, Wilimas JA, et al. Thrombolytic therapy for central venous catheter occlusion. Haematologica, 2012, 97(5): 641-650.
76. Westergaard B, Classen V, Walther-Larsen S. Peripherally inserted central catheters in infants and children - indications, techniques, complications and clinical recommendations. Acta Anaesthesiol Scand, 2013, 57(3): 278-287.
77. Bolton D. Preventing occlusion and restoring patency to central venous catheters. Br J Community Nurs, 2013, 18(11): 539-540.
78. Giordano P, Saracco P, Grassi M, et al. Recommendations for the use of long-term central venous catheter (CVC) in children with hemato-oncological disorders: management of CVC-related occlusion and CVC-related thrombosis. Ann Hematol, 2015, 94(11): 1765-1776.
79. Rowan CM, Miller KE, Beardsley AL, et al. Alteplase use for malfunctioning central venous catheters correlates with catheter-associated bloodstream infections. Pediatr Crit Care Med, 2013, 14(3): 306-309.
80. Thakarar K, Collins M, Kwong L, et al. The role of tissue plasminogen activator use and systemic hypercoagulability in central line-associated bloodstream infections. Am J Infect Control, 2014, 42(4): 417-420.
81. Pai VB, Plogsted S. Efficacy and safety of using L-cysteine as a catheter-clearing agent for nonthrombotic occlusions of central venous catheters in children. Nutr Clin Pract, 2014, 29(5): 636-638.

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