Tunneled catheter thrombosis: factors related to incidence.

Quasi-experimental and descriptive methods were used to investigate thrombosis incidence in 294 tunneled central venous catheters inserted in adult clients with cancer. Thrombosis incidence was measured in relation to heparin flush regimen, internal catheter tip location, and chemotherapy infusate volume. Data were collected for two cohorts: 1) 145 tunneled catheters using 5 ml daily of 10 U/ml heparin flush, and 2) 51 catheters using 10 cc daily of 100 U/ml heparin flush. Data were also collected for an additional 98 catheters (transitional) utilizing a combination of flush #1 and #2 from adjacent time periods. Chi square analysis of the cohorts revealed no difference in thrombosis incidence by flush regimen or chemotherapy infusate volume. Suboptimal internal catheter tip location and catheters placed on the left side were related to higher thrombosis incidence. Practice implications include: the need for staff and patient education regarding signs and symptoms of catheter-related thrombosis, additional systematic data collection and evaluation, and support for empirical research to establish optimal vascular access device care.