Thrombolytic Therapy Using Urokinase for Management of Central Venous Catheter Thrombosis

Abstract

Purpose:The management of central venous catheters (CVCs) and catheter thrombosis vary among centers, and the efficacy of the methods of management of catheter thrombosis in CVCs is rarely reported. We investigated the efficacy of bedside thrombolysis with urokinase for the management of catheter thrombosis.Materials and Methods:We retrospectively reviewed data from patients who had undergone CVC insertion by a single surgeon in a single center between April 2012 and June 2014. We used a protocol for the management of CVCs and when catheter thrombosis was confirmed, 5,000 U urokinase was infused into the catheter.Results:A total of 137 CVCs were inserted in 126 patients. The most common catheter-related complication was thrombosis (12, 8.8%) followed by infection (8, 5.8%). Nine of the 12 patients (75%) with catheter thrombosis were recanalized successfully with urokinase. The rate of CVC recanalization was higher in the peripherally inserted central catheter (PICC) group (87.5%) than the chemoport group (50%). Reintervention for catheter-related thrombosis was needed in only 2.2% of patients when thrombolytic therapy using urokinase was applied. Age <60 years (P=0.035), PICC group (P=0.037) and location of the catheter tip above the superior vena cava (P=0.044) were confirmed as independent risk factors for catheter thrombosis.Conclusion:Thrombolysis therapy using urokinase could successfully manage CVC thrombosis. Reintervention was rarely needed when a protocol using urokinase was applied for the management of CVC thromboses.

Evaluation of complications of totally implantable central venous port system insertion

“…In cases of catheter migration or catheter tip malposition, catheter malfunction, pain or swelling may occur. Son et al (23) reported that the risk for catheter thrombosis was high when the catheter tip was above the superior vena cava.…”

The feasibility and safety of PICCs accessed via the superficial femoral vein in patients with superior vena cava syndrome

“…Although there is no significant difference in this study, the incidence of exudation in the FICC group seemed to be higher than the upper extremity veins PICCs group (5.43% vs. 3.61%). Exudation from insertion site may relate to hypoproteinemia, coagulation disorders, formation of catheter fibrin sheath, lymphatic damage, or catheter allergy (19, 20). Cancer patients with SVCS are often in a serious condition and have poor nutritional status, edema caused by hypoproteinemia or coagulation disorders may be the main reason for exudation in FICC group.…”

Vascular access for red blood cell exchange

“…CVC lumens can be occluded due to thrombus formation, which usually develops gradually, with intermittent resistance during catheter flushing until it becomes completely occluded. If change of posture does not enable blood aspiration, then thrombolytic agents, such as alteplase or urokinase, should be infused into the blocked catheter lumen …”

“…If change of posture does not enable blood aspiration, then thrombolytic agents, such as alteplase or urokinase, should be infused into the blocked catheter lumen. 81,82 Insertion of CVCs should be performed or supervised by experienced physicians. The risk of mechanical complications significantly increases with more than three attempts at catheter insertion.…”