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Intraluminal instillation of urokinase and autologous plasma: a method to unblock occluded central venous ports
© Seifert et al; licensee BioMed Central Ltd. 2006
Received: 10 November 2005
Accepted: 24 April 2006
Published: 24 April 2006
Therapeutic use and effective function of recombinant urokinase (r-UK) for occluded ports need the presence of plasminogen.
As a therapeutic proof of principle, we demonstrate that the use of r-UK and autologous plasma effectively reestablishes the function of occluded central venous ports (CVP) resistant to routine management of catheter occlusion. Five patients with occluded ports resistant to the routine management were treated.
All patients were successfully treated with thrombolytic therapy using intraluminal instillation of r-UK and autologous plasma.
Instillation of r-UK and autologous plasma is a safe and effective method for management of CVP occlusion.
Fluorouracil, Folic Acid
Fluorouracil, Folic Acid
We report on five patients with an CVP occlusion that could not be managed by routine procedures. All patients had internal jugular CVPs, which had all been implanted in a surgical unit. The indications for CVP placement were regular infusion of plasma products, chemotherapy and antibiotics. We tested the new method described in this paper as a last resort before catheter replacement. All instillations resulted in successful reestablishment of catheter function after approximately 60 minutes of urokinase/plasma instillation. No patient experienced adverse effects during or after instillation. No bleeding complications occurred. The entire management procedure was easy to perform and well tolerated. In one case the instillation of urokinase and plasma failed. The explanted CVP showed that a silicon particle, which had originated during puncture, had occluded the CVP.
Catheter occlusion is a common complication of long-term CVP placement. Therapeutic fibrinolytic agents like r-UK or r-tPA are used successfully to restore function of occluded CVP [1, 2] Generally one or two instillationsof r-UK are required in the majority of patients. A 98.1% patency rate is reported when treating catheter occlusions in paediatric patients with r-UK at a concentration of 5,000 IU/mL  However, after repeated applications of plasminogen activators, a clot may become deprived of plasminogen. This will result in the failure of further attempts.
The method we have described in this paper is useful in such situations. We were able to avoid catheter replacement in all five patients with thrombotic catheter occlusions that were treated with r-UK and autologous plasma. This is especially important for children.
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- The pre-publication history for this paper can be accessed here:http://www.biomedcentral.com/1471-2407/6/103/prepub
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