Maintaining the patency of double-lumen silastic jugular catheters for haemodialysis.
A system has been developed for maintaining the patency of double lumen silastic jugular catheters in patients with refractory vascular access problems. Most patients receive a small daily dose of aspirin. Selected patients also receive warfarin to maintain a prothrombin time (PT) of 15, 20, or 30 seconds. Inadequate blood flow due to thrombus obstruction can be overcome by the intravenous administration of urokinase, 250.000 units. This can be administered safely to outpatients provided that heparin is not given simultaneously. Occasionally a second dose may be required. By adopting this policy all catheter obstructions have been overcome. The danger of iatrogenic bleeding cannot be discounted. Warfarin therapy must be very closely monitored.
Uldall
R
R
Division of Nephrology, Toronto Hospital, Canada.
Besley
M E
ME
Thomas
A
A
Salter
S
S
Nuezca
L A
LA
Vas
M
M
D001241:Aspirin / Q000627:therapeutic use; D002405:Catheterization, Central Venous / Q000009:adverse effects; D002408:Catheters, Indwelling / Q000009:adverse effects; D005260:Female; D006801:Humans; D007601:Jugular Veins; D008297:Male; D006435:Renal Dialysis; D014568:Urokinase-Type Plasminogen Activator / Q000627:therapeutic use; D014859:Warfarin / Q000627:therapeutic use
D014859:Warfarin; D014568:Urokinase-Type Plasminogen Activator; D001241:Aspirin