Name of the Procedure:

Declotting by Thrombolytic Agent of Implanted Vascular Access Device or Catheter

Summary

Declotting by thrombolytic agent is a medical procedure used to remove blood clots from implanted vascular access devices or catheters. This helps restore proper function to the device, ensuring that it can be used for administering medications, drawing blood, or other necessary treatments.

Purpose

The procedure addresses the blockage of vascular access devices due to blood clots. The goals are to restore the full function of the device, minimize interruptions in treatment, and prevent complications such as infection or the need for device replacement.

Indications

• Sluggish or completely blocked catheter
• Difficulty in withdrawing blood from the catheter
• Inadequate flow of intravenous medications
• Symptoms such as swelling, redness, or pain around the catheter site
• Patients with long-term catheter use

Preparation

• Patients may be advised to refrain from eating or drinking for a few hours prior to the procedure.
• Healthcare providers may review the patient's medication list, possibly advising adjustments, especially with anticoagulants.
• Diagnostic tests such as blood work and imaging studies might be performed to confirm clot presence and assess overall health.

Procedure Description

1. Assessment and Preparation: The healthcare provider will assess the catheter site and discuss the procedure with the patient.
2. Administration of Thrombolytic Agent: A thrombolytic agent, such as alteplase, will be injected into the catheter. This agent helps dissolve the clot.
3. Dwell Time: The agent is left in place for a specified period, typically between 30 minutes to 2 hours.
4. Flushing the Catheter: After the dwell time, the catheter is flushed with saline to remove the dissolved clot.
5. Verification of Patency: The function of the catheter is checked by attempting to withdraw blood and infuse fluids.

Tools and Equipment:

• Thrombolytic agent (e.g., alteplase)
• Saline solution
• Syringes and sterile gloves

Anesthesia: Usually, no anesthesia is required for this procedure.

Duration

The procedure typically takes about 1 to 3 hours, including the dwell time for the thrombolytic agent.

Setting

The procedure can be performed in various settings, including hospitals, outpatient clinics, or specialized surgical centers.

Personnel

• Registered nurse (RN)
• Interventional radiologist or physician overseeing the procedure
• Medical assistants

Risks and Complications

• Common Risks: Minor bleeding or bruising at the catheter site, allergic reactions to the thrombolytic agent.
• Rare Risks: Significant bleeding, infection, and blood clot migration. These complications are managed with appropriate medical interventions.

Benefits

• Restored catheter function
• Avoidance of catheter replacement surgery
• Continued access for essential treatments
• Benefits are typically realized immediately after the procedure

Recovery

• Patients can usually resume normal activities shortly after the procedure.
• Post-procedure instructions might include monitoring for signs of infection or bleeding and instructions on catheter care.
• Follow-up appointments may be scheduled to ensure ongoing catheter function.

Alternatives

• Catheter replacement: requires a surgical procedure with associated risks.
• Mechanical declotting: a more invasive technique.
• Pros: Chemical declotting is less invasive and quicker.
• Cons: May not be effective in all cases, where mechanical methods might be necessary.

Patient Experience

• Patients might feel slight discomfort during the injection of the thrombolytic agent.
• Most patients do not require pain medication, but over-the-counter pain relief can be used if needed.
• The overall experience is generally well-tolerated with minimal discomfort.