title: Continuous infusion of low-dose urokinase in the treatment of central venous catheter thrombosis in infants and children.
abstract: Thrombotic occlusion is a frequent complication associated with the use of central venous catheters. The purpose of this study was to evaluate the efficacy of a continuous infusion of low-dose urokinase (200 U/kg/h) in clearing catheters that had not cleared after two bolus doses of urokinase in a pediatric oncology population. Fifty-eight incidents of catheter-related occlusions (49 Hickman-type catheters/nine implantable ports) as documented by radiographic dye study occurred in 227 pediatric oncology patients with 254 central venous catheters during a 1-year period. Fourteen of 58 catheters failed to clear after two bolus instillations of urokinase (5,000 U and 10,000 U). Thirteen catheters were treated for 24 hours with urokinase, 200 U/kg/h, and one catheter with urokinase, 100 U/kg/h for 24 hours. Twelve catheters were used for study. Coagulation studies were monitored preinfusion, 12 hours into the infusion, and postinfusion. Patency was reestablished in 11/12 catheters (92%) with a mean infusion time of 28.7 hours. No coagulation abnormalities or clinical bleeding associated with the urokinase infusion occurred. Only one patient exhibited a prolonged partial thromboplastin time (greater than 150 seconds); this was associated with a heparin effect. These data indicate that low-dose urokinase may be a safe and effective means to clear occluded central venous catheters in children.
authors.affiliation: Division of Pediatric Surgery, Children's Hospital of Los Angeles, CA 90027.
authors.forename: H A
authors.initials: HA
authors.lastname: Bagnall
authors.forename: E
authors.initials: E
authors.lastname: Gomperts
authors.forename: J B
authors.initials: JB
authors.lastname: Atkinson
mesh_terms: D001777:Blood Coagulation / Q000187:drug effects; D002405:Catheterization, Central Venous / Q000009:adverse effects*; D002648:Child; D002675:Child, Preschool; D004341:Drug Evaluation; D004395:Dye Dilution Technique; D006325:Heart Atria; D006801:Humans; D007262:Infusions, Intravenous; D013927:Thrombosis / Q000097:blood / Q000175:diagnosis / Q000188:drug therapy* / Q000209:etiology; D013997:Time Factors; D014568:Urokinase-Type Plasminogen Activator / Q000008:administration & dosage* / Q000009:adverse effects
chemical_list: D014568:Urokinase-Type Plasminogen Activator