Son Jung Tack, Min Sun Young, Kim Jae Il, Choi Pyong Wha, Heo Tae Gil, Lee Myung Soo, Kim Chul-Nam, Kim Hong-Yong, Yi Seong Yoon, Lee Hye Ran, Roh Young-Nam
Departments of Surgery, Ilsan Paik Hospital, Inje University College of Medicine, Goyang, Korea.
Internal Medicine, Ilsan Paik Hospital, Inje University College of Medicine, Goyang, Korea.
Vasc Specialist Int. 2014 Dec;30(4):144-50. doi: 10.5758/vsi.2014.30.4.144. Epub 2014 Dec 31.
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.
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.
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.
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.
中心静脉导管（CVC）及导管血栓形成的管理在各中心有所不同，而CVC导管血栓形成管理方法的疗效鲜有报道。我们研究了用尿激酶进行床旁溶栓治疗导管血栓形成的疗效。
我们回顾性分析了2012年4月至2014年6月间在单一中心由单一外科医生进行CVC置入的患者数据。我们采用了CVC管理方案，当确认导管血栓形成时，将5000单位尿激酶注入导管。
126例患者共置入137根CVC。最常见的导管相关并发症是血栓形成（12例，8.8%），其次是感染（8例，5.8%）。12例导管血栓形成患者中有9例（75%）用尿激酶成功再通。外周置入中心静脉导管（PICC）组的CVC再通率（87.5%）高于化疗端口组（50%）。应用尿激酶溶栓治疗时，仅2.2%的患者需要对导管相关血栓形成进行再次干预。年龄<60岁（P = 0.035）、PICC组（P = 0.037）和导管尖端位于上腔静脉上方（P = 0.044）被确认为导管血栓形成的独立危险因素。
使用尿激酶的溶栓治疗可成功处理CVC血栓形成。应用尿激酶方案管理CVC血栓形成时很少需要再次干预。
