Lytic therapy in central venous catheters for hemodialysis. (Continuing Education)

Over the past 2 decades the use of central venous catheters (CVCs) for hemodialysis has become commonplace. While these devices have provided much needed temporary access to the bloodstream, they often become thrombosed and require procedures to restore patency. This article examines the lytic enzymes that are currently available and focuses on the assessment and treatment of thrombosis. Goal: To discuss the characteristics, pathophysiology, and assessment of thrombosed central venous catheters and their treatment with lytic enzymes. Objectives: 1. Describe the pathophysiology of thrombotic occlusions of CVCs. 2. Summarize the current lytic enzymes available and their pros and cons. 3. List the steps in the assessment of the malfunctioning CVC and treatment with a lytic enzyme.
The use of central venous catheters (CVCs) for hemodialysis began in 1979 with the advent of the single lumen Uldall subclavian catheter (Uldall, Woods, Bird, & Dyck, 1979). Prior to [...]