Weekly prophylactic urokinase instillation in tunneled central venous access devices.
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.
Ray
C E
CE
Department of Interventional Radiology, Roswell Park Cancer Institute, Buffalo, NY, USA.
Shenoy
S S
SS
McCarthy
P L
PL
Broderick
K A
KA
Kaufman
J A
JA
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*
D005343:Fibrinolytic Agents; D006493:Heparin; D010960:Plasminogen Activators; D014568:Urokinase-Type Plasminogen Activator