High-dose intradialytic urokinase to restore the patency of permanent central vein hemodialysis catheters

Zj, Twardowski

doi:10.1016/s0272-6386(98)70054-x

Cited by 67 publications

(58 citation statements)

References 8 publications

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“…After 15 min, the urokinase was withdrawn and the dialysis was continued. When a blood flow of Ͼ200 ml/min was not achieved after this procedure, 100,000 to 250,000 IU of urokinase could be infused in 3 h during dialysis according to the protocol of Twardowski (26). In case of total occlusion of the lumen (i.e., no flow when connected to the dialysis machine), 40,000 IU/h urokinase during 3 h could be infused in the lumen of the catheter.…”

Section: Thrombosismentioning

confidence: 99%

Randomized, Clinical Trial Comparison of Trisodium Citrate 30% and Heparin as Catheter-Locking Solution in Hemodialysis Patients

Weijmer¹,

Dorpel²,

Ven³

et al. 2005

Journal of the American Society of Nephrology

271

253

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Interdialytic hemodialysis catheter-locking solutions could contribute to a reduction of catheter-related complications, especially infections. However, they can cause side effects because of leakage from the tip of the catheter. Recently, trisodium citrate (TSC) has been advocated because of its antimicrobial properties and local anticoagulation. In a multicenter, doubleblind, randomized, controlled trial, TSC 30% was compared with unfractionated heparin 5000 U/ml for prevention of catheter-related infections, thrombosis, and bleeding complications. The study was stopped prematurely because of a difference in catheter-related bacteremia (CRB; P < 0.01). Of 363 eligible patients, 291 could be randomized. The study included 98 tunneled cuffed catheters and 193 untunneled. There were no significant differences in patient and catheter characteristics on inclusion. In the heparin group, 46% of catheters had to be removed because of any complication compared with 28% in the TSC group (P ‫؍‬ 0.005). CRB rates were 1.1 per 1000 catheter-days for TSC versus 4.1 in the heparin group (P < 0.001). For tunneled cuffed catheters, the risk reduction for CRB was 87% (P < 0.001) and for untunneled catheters was 64% (P ‫؍‬ 0.05). Fewer patients died from CRB in the TSC group (0 versus 5; P ‫؍‬ 0.028). There were no differences in catheter flow problems and thrombosis (P ‫؍‬ 0.75). No serious adverse events were encountered. Major bleeding episodes were significantly lower in the TSC group (P ‫؍‬ 0.010). TSC 30% improves overall patency rates and reduces catheter-related infections and major bleeding episodes for both tunneled and untunneled hemodialysis catheters. Flow problems are not reduced.

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Section: Thrombosismentioning

confidence: 99%

Randomized, Clinical Trial Comparison of Trisodium Citrate 30% and Heparin as Catheter-Locking Solution in Hemodialysis Patients

Weijmer¹,

Dorpel²,

Ven³

et al. 2005

Journal of the American Society of Nephrology

271

253

View full text Add to dashboard Cite

show abstract

“…After 15 min the urokinase was withdrawn. If a blood flow of >200 ml/min was not achieved after this procedure, 100 000-250 000 IU of urokinase could be infused in 3 h during dialysis according to the protocol of Twardowski [8]. When this was not successful, the catheter was removed or exchanged.…”

Section: Catheters Catheter Care Protocol and Catheter Outcome Assesmentioning

confidence: 99%

Prospective follow-up of a novel design haemodialysis catheter; lower infection rates and improved survival

Weijmer

Vervloet

Wee

2007

Nephrology Dialysis Transplantation

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Background. Untunnelled straight jugular catheters (USC) are uncomfortable for patients and cannot be well fixated. This could be a reason for the high incidence of catheterrelated complications. Methods. We prospectively analysed the outcome of a novel designed untunnelled precurved catheter (UPC) with better fixation properties and compared it with the outcome of USC. The outcome was also related to data on tunnelled cuffed catheters (TCC). Results. The outcome of USC was documented over a 32-month period. Thereafter, we switched to an UPC. The same catheter care protocol was used and not changed over time. A total of 104 USC and 65 UPC were inserted. Compared to USC, less UPC had to be removed for a complication (53 versus 15%; P < 0.001) and less periods of catheterrelated bacteraemia were observed in UPC compared to USC [0 versus 5.6 per 1000 catheter days (cd); P < 0.01]. Removal for flow problems was similar. Compared to 64 TCC, inserted in the same period, UPC had more flow problems. Other outcomes and complication rates were similar. Complication rates for TCC inserted before and after the switch from USC to UPC were similar. Conclusions. UPC have better patency rates and a lower risk for bacteraemia and exit-site infection compared to USC.

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“…Systemic anticoagulation to prevent catheter thrombosis has been recommended by experts in the field (8,9). However, direct evidence has been lacking, and a 2007 Cochrane review of patients with centralvenous catheters for management of cancer found that treatment with vitamin K antagonists did not reduce the risk of symptomatic deep venous thrombosis (10).…”

Section: Introductionmentioning

confidence: 99%

Low-Intensity Adjusted-Dose Warfarin for the Prevention of Hemodialysis Catheter Failure

Wilkieson

Ingram

Crowther

et al. 2011

Clinical Journal of the American Society of Nephrology

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SummaryBackground and objectives To determine whether warfarin prolongs the time to first mechanical-catheter failure.Design, setting, participants, & measurements This was a multicenter parallel-group randomized controlled trial with blinding of participants, trial staff, clinical staff, outcome assessors, and data analysts. Randomization was in a 1:1 ratio in blocks of four and was concealed by use of fax to a central pharmacy. Hemodialysis patients with newly-placed catheters received low-intensity monitored-dose warfarin, target international normalized ratio (INR) 1.5 to 1.9, or placebo, adjusted according to schedule of sham INR results. The primary outcome was time to first mechanical-catheter failure (inability to establish a circuit or blood flow less than 200 ml/min). ResultsWe randomized 174 patients: 87 to warfarin and 87 to placebo. Warfarin was associated with a hazard ratio (HR) of 0.90 (P ϭ 0.60; 95% confidence interval [CI], 0.57, 1.38) for time to first mechanical-catheter failure. Secondary analyses were: time to first guidewire exchange or catheter removal for mechanical failure (HR 0.78; 95% CI, 0.37, 1.6); time to catheter removal for mechanical failure (HR 0.67; 95% CI, 0.19, 2.37); and time to catheter removal for any cause (HR 0.89; 95% CI, 0.42, 1.81). Major bleeding occurred in 10 participants assigned to warfarin and seven on placebo (relative risk, 1.43; 95% CI, 0.57, 3.58; P ϭ 0.61). ConclusionsWe found no evidence for efficacy of low-intensity, monitored-dose warfarin in preventing mechanical-catheter failure.

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High-dose intradialytic urokinase to restore the patency of permanent central vein hemodialysis catheters

Cited by 67 publications

References 8 publications

Randomized, Clinical Trial Comparison of Trisodium Citrate 30% and Heparin as Catheter-Locking Solution in Hemodialysis Patients

Randomized, Clinical Trial Comparison of Trisodium Citrate 30% and Heparin as Catheter-Locking Solution in Hemodialysis Patients

Prospective follow-up of a novel design haemodialysis catheter; lower infection rates and improved survival

Low-Intensity Adjusted-Dose Warfarin for the Prevention of Hemodialysis Catheter Failure

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