A Sensible Solution to Clogged Central Venous Catheters

Central venous catheter (CVC) occlusion is a common issue in patients being treated for chronic illnesses, but a recent study showed the anti-clotting drug alteplase is an effective way to solve the problem that’s significantly less costly than replacing the catheters altogether.

The retrospective analysis of roughly 1,000 patients who had occluded catheters replaced with new lines and approximately 34,500 patients who received 2 mg alteplase revealed the average cost-per-day and overall total costs of caring for alteplase patients was $317 lower and nearly $1,419 less, respectively. The savings included lower hospital expenditures related to surgical care, radiology tests, and supply costs. Lengths of stay and readmission rates at 30 and 90 days were similar between both groups, according to the study.

Overall and average daily pharmacy costs increased by $1,115 and $99, respectively, for patients who had catheters replaced, while corresponding costs in patients who received alteplase dropped by $100 and $21. The researchers were unsure of the reasons behind the cost discrepancies, but said it suggested the catheter-replacement patients received additional medications.

CVC occlusion can be caused by inappropriate medication concentrations or incompatible mixtures solidifying within a catheter’s lumen and occurs in as many as 36% of catheters within 1 to 2 years of placement, according to the researchers. A single dose of 2 mg alteplase, noted by the study as the only FDA-approved thrombolytic used to restore CVC function and the standard of care for freeing catheter blockages, has been shown to clear occlusions after 2 hours in 74% of patients compared with only 17% of patients who received a placebo.

Although reducing length of hospital stays is the focus of most healthcare outcomes research, the study authors argued that the cost of care could simply be allocated to earlier parts of patients’ hospitalizations. In contrast, the cost benefit of using alteplase in this study was based on limiting the utilization of core resources, which the researchers called a “powerful” chance to limit hospital expenditures.

“Finding opportunities to reduce healthcare costs without negatively impacting quality of care is the name of the game,” they wrote.

The study was published online in the Journal of Hospital Medicine.

—Dan Cook

Reference:

1. Ernst FR, Chen E, Lipkin C, Tayama D, Amin AN. Comparison of hospital length of stay, costs, and readmissions of alteplase versus catheter replacement among patients with occluded central venous catheters. J Hosp Med. 2014 May 14. [Epub ahead of print]