Renal & Diabetes Center, Glan Clwyd Hospital, Rhyl, UK.
Royal Marsden Hospital NHS Trust (Retired), UK.
J Vasc Access. 2021 Jul;22(4):568-574. doi: 10.1177/1129729820950997. Epub 2020 Sep 1.
Central venous catheter dysfunction may be associated with intraluminal clots, drug precipitates and lipid residues or extra luminal causes such as fibroblastic sleeve, tip malposition, pinch-off syndrome and venous thrombosis at the tip of central venous catheter. Failure to restore patency after addressing these causes, empirical treatment with thrombolytic agents should be considered. Urokinase is used widely as a thrombolytic agent but very few outcome studies have been published.
A multicentre group conducted a prospective audit of management of central venous catheter dysfunction after exclusion of common causes using in centre standardised doses of urokinase from September 2017 to February 2018 in haematology and oncology units. Data of catheter blood flow were collected anonymously following administration of 5000- to 25,000-IU urokinase in dysfunctional central venous catheter.
A total of 117 patients were recruited from eight centres, 54 females and 63 males, median age was 60 (46-68). In total, 53% presented as partial withdrawal occlusion and 47% total occlusion. In partial withdrawal occlusion, patency was restored in 80% of interventions, in 82% of interventions using push lock and in 76% using dwell lock. In total occlusion, patency was restored in 88% of the interventions. The central venous catheter clearance rate was dose dependent; patency was restored in 83% of central venous catheter with 5000 IU, 89% with 10,000 IU and 92% with high dose of 25,000 IU. No adverse events were recorded.
In this study, treatment of dysfunctional central venous catheter using standardised urokinase doses was safe and effective in restoring patency when no other mechanical causes could account for central venous catheter dysfunction.
中心静脉导管功能障碍可能与管腔内血栓、药物沉淀和脂质残留或管外原因有关，如成纤维细胞套、尖端位置不当、夹闭综合征和中心静脉导管尖端的静脉血栓形成。在解决这些原因后，如果仍无法恢复通畅，则应考虑使用经验性溶栓药物治疗。尿激酶广泛用作溶栓药物，但很少有研究报道其结局。
一个多中心小组在 2017 年 9 月至 2018 年 2 月期间，排除常见原因后，在血液科和肿瘤科使用中心标准化剂量的尿激酶，对中心静脉导管功能障碍的管理进行了前瞻性审核。在功能障碍的中心静脉导管中给予 5000-25000IU 尿激酶后，匿名收集导管血流数据。
从 8 个中心共招募了 117 名患者，其中 54 名女性，63 名男性，中位年龄为 60（46-68）岁。总的来说，53%的患者表现为部分拔出性闭塞，47%的患者表现为完全闭塞。在部分拔出性闭塞中，80%的干预措施恢复了通畅，使用推注锁定的干预措施中 82%恢复了通畅，使用停留锁定的干预措施中 76%恢复了通畅。在完全闭塞中，88%的干预措施恢复了通畅。中心静脉导管通畅率与剂量相关；5000IU 的中心静脉导管通畅率为 83%，10000IU 的中心静脉导管通畅率为 89%，高剂量 25000IU 的中心静脉导管通畅率为 92%。未记录到不良事件。
在这项研究中，使用标准化尿激酶剂量治疗功能障碍的中心静脉导管是安全有效的，可以恢复通畅，当没有其他机械原因可以解释中心静脉导管功能障碍时。
