title: Weekly prophylactic urokinase instillation in tunneled central venous access devices.
abstract: OBJECTIVE
  To determine the safety and efficacy of weekly prophylactic urokinase therapy in tunneled central venous access devices (VADs).
  
  
  METHODS
  A prospective, randomized study was performed in 105 patients who underwent tunneled VAD placement between March 1997 and April 1998. The patients were randomized to receive either twice-daily heparin flushes (14 heparin flushes per week; group A, n = 52) or twice-daily heparin flushes with once-weekly urokinase (UK) instillation (13 heparin flushes, one UK flush per week; group B, n = 53). Patients were followed up by examination and/or interview at 1, 3, and 6 months for signs and symptoms of delayed catheter-related complications.
  
  
  RESULTS
  The total number of indwelling catheter-days was similar between groups (5,450 in group A, 5,276 in group B). The total number of infectious complications and fibrin sheaths formed was greater for group A (n = 11; 21.1%) than group B (n = 3; 5.7%) (P = .02). There were no side effects noted from the prophylactic UK administrations.
  
  
  CONCLUSIONS
  Prophylactic UK is advantageous in preventing delayed catheter-related complications.
authors.affiliation: Department of Interventional Radiology, Roswell Park Cancer Institute, Buffalo, NY, USA.
authors.forename: C E
authors.initials: CE
authors.lastname: Ray
authors.forename: S S
authors.initials: SS
authors.lastname: Shenoy
authors.forename: P L
authors.initials: PL
authors.lastname: McCarthy
authors.forename: K A
authors.initials: KA
authors.lastname: Broderick
authors.forename: J A
authors.initials: JA
authors.lastname: Kaufman
mesh_terms: D000328:Adult; D000368:Aged; D002405:Catheterization, Central Venous / Q000295:instrumentation*; D002408:Catheters, Indwelling; D004359:Drug Therapy, Combination; D005260:Female; D005343:Fibrinolytic Agents / Q000627:therapeutic use; D006493:Heparin / Q000627:therapeutic use; D006801:Humans; D007322:Instillation, Drug; D008297:Male; D008875:Middle Aged; D010690:Phlebography; D010960:Plasminogen Activators / Q000008:administration & dosage*; D011446:Prospective Studies; D016459:Prosthesis-Related Infections / Q000175:diagnosis / Q000517:prevention & control*; D012449:Safety; D016896:Treatment Outcome; D014463:Ultrasonography; D014568:Urokinase-Type Plasminogen Activator / Q000008:administration & dosage*; D014683:Vena Cava, Superior / Q000000981:diagnostic imaging; D020246:Venous Thrombosis / Q000175:diagnosis / Q000517:prevention & control*
chemical_list: D005343:Fibrinolytic Agents; D006493:Heparin; D010960:Plasminogen Activators; D014568:Urokinase-Type Plasminogen Activator