Management of occlusion and thrombosis associated with long-term indwelling central venous catheters

Lancet. 2009 Jul 11;374(9684):159-69. doi: 10.1016/S0140-6736(09)60220-8.


Long-term central venous catheters (CVCs) are important instruments in the care of patients with chronic illnesses, but catheter occlusions and catheter-related thromboses are common complications that can result from their use. In this Review, we summarise management of these complications. Mechanical CVC occlusions need cause-specific treatment, whereas thrombotic occlusions usually resolve with thrombolytic treatment, such as alteplase. Prophylaxis with thrombolytic flushes might prevent CVC infections and catheter-related thromboses, but confirmatory studies and cost-effectiveness analysis of this approach are needed. Risk factors for catheter-related thromboses include previous catheter infections, malposition of the catheter tip, and prothrombotic states. Catheter-related thromboses can lead to catheter infection, pulmonary embolism, and post-thrombotic syndrome. Catheter-related thromboses are usually diagnosed by Doppler ultrasonography or venography and treated with anticoagulation therapy for 6 weeks to a year, dependent on the extent of the thrombus, response to initial therapy, and whether thrombophilic factors persist. Prevention of catheter-related thromboses includes proper positioning of the CVC and prevention of infections; anticoagulation prophylaxis is not currently recommended.

Publication types

  • Research Support, N.I.H., Extramural
  • Research Support, Non-U.S. Gov't
  • Review

MeSH terms

  • Algorithms
  • Anticoagulants / therapeutic use
  • Biomechanical Phenomena
  • Catheterization, Central Venous / adverse effects*
  • Catheters, Indwelling / adverse effects*
  • Clinical Protocols
  • Decision Trees
  • Equipment Failure
  • Fibrinolytic Agents / therapeutic use
  • Humans
  • Phlebography
  • Practice Guidelines as Topic
  • Primary Prevention
  • Risk Factors
  • Therapeutic Irrigation
  • Thrombosis* / diagnosis
  • Thrombosis* / etiology
  • Thrombosis* / therapy
  • Ultrasonography, Doppler


  • Anticoagulants
  • Fibrinolytic Agents