Efficacy and Safety of Using L-cysteine as a Catheter-Clearing Agent for Nonthrombotic Occlusions of Central Venous Catheters in Children

Title

Efficacy and Safety of Using L-cysteine as a Catheter-Clearing Agent for Nonthrombotic Occlusions of Central Venous Catheters in Children

Creator

Pai V B; Plogsted S

Publisher

Nutrition in Clinical Practice

Date

2014
2014-10

Description

Critically ill pediatric patients, especially in the intensive care unit, receive multiple medications and have a higher risk of central venous catheter (CVC) occlusion. If an occlusion occurs immediately after the administration of multiple medications or incompatible medications, either an acidic solution such as 0.1 N hydrochloric acid (HCl) or a basic solution of 1 mEq/mL sodium bicarbonate or 0.1 N sodium hydroxide can be used. However, compounding and storing of 0.1 N HCl has become more complex due to USP <797> guidelines for sterile compounding, and an alternative is needed. We report a series of cases in which L-cysteine was used instead of HCl to clear CVCs occluded due to administration of multiple medications. L-cysteine is a commercially available, sterile solution with a pH of 1-2.5. CVC occlusion was resolved in 10 of the 16 episodes in 13 patients. Two of the 16 occlusions were phenytoin related and would not have responded. An L-cysteine dose of 50 mg was used during 10 of the 16 episodes, 100 mg during 5 episodes, and 25 mg during 1 episode. A correlation between catheter clearance and dose was not observed. Occlusion resolution due to L-cysteine was not correlated to the prior use of tissue plasminogen activator. Metabolic acidosis, adverse effects, or damage to the catheters due to L-cysteine were not observed. On the basis of this limited experience, we propose L-cysteine as an effective alternative to 0.1 N HCl for clearing CVC occlusions caused by drugs with an acidic pKa.

Subject

alteplase; catheter obstruction; catheters; central venous; ethanol; hydrochloric-acid; L-cysteine; Nutrition & Dietetics; occlusion; parenteral nutrition; tissue-plasminogen activator; trial

Format

Journal Article

Search for Full-text

Users with a NEOMED Library login can search for full-text journal articles at the following url: https://libraryguides.neomed.edu/home

Rights

Article information provided for research and reference use only. All rights are retained by the journal listed under publisher and/or the creator(s).

Pages

636-638

Issue

5

Volume

29

Citation

Pai V B; Plogsted S, “Efficacy and Safety of Using L-cysteine as a Catheter-Clearing Agent for Nonthrombotic Occlusions of Central Venous Catheters in Children,” NEOMED Bibliography Database, accessed February 25, 2021, https://neomed.omeka.net/items/show/6705.

Social Bookmarking