Efficacy of urokinase lock to treat thrombotic dysfunction of tunneled hemodialysis catheters: A retrospective cohort study

• Published in: The journal of vascular access 2019-01, Vol.20 (1), p.60-69
• Main Authors: Van Hulle, Freya, Bonkain, Florence, De Clerck, Dieter, Aerden, Dimitri, Vanwijn, Isabelle, Tielemans, Christian, Wissing, Karl Martin
• Format: Article
• Language: English
• ISSN: 1129-7298; 1724-6032
• DOI: 10.1177/1129729818779549

Background: There are few data to inform decisions about the optimal management of occluded tunneled cuffed hemodialysis catheters with thrombolytic locking solutions. The effect of dose, dwell-time, and number of administrations remains controversial. Methods: In this retrospective single-center review of tunneled cuffed catheters used between 2010 and 2014, restoration of blood flow as well as pre- and post-pump pressures after either short (30 min) or prolonged (48–72 h) administration of 100,000 IU of urokinase locking solution was evaluated in all thrombotic dysfunctions. We also assessed if multiple urokinase locks for the same thrombotic dysfunction event were more efficient to restore catheter performance than single administration. Results: Data on 773 thrombotic events in 148 patients (236 catheters) were collected during observation period. After urokinase treatment, blood flow and pre-pump pressure improved (median of 50 mL/min and 20 mmHg) whereas post-pump pressure decreased (median of 15 mmHg) (all P