THROMBOLYTIC THERAPY USING UROKINASE FOR MANAGEMENT OF CVC IN HEMODIALYSIS: OUR EXPERIENCE.
(Abstract release date: 05/19/16)
EHA Library. Bruzzese A. 06/09/16; 135103; PB2203
Dr. Antonella Bruzzese
Contributions
Contributions
Abstract
Abstract: PB2203
Type: Publication Only
Background
The need to use the CVC (central venous catheter) for hemodialysis is an occurrence in growth, related to the aging of the population on dialysis and the high prevalence of the disease and thrombotic angiosclerotica-uremic coaugulativa of the subject. The CVC is almost always a second best solution precisely in those subjects with situations of vascular compromise and / or coagulation disorder that does not allow the creation of the FAV (arteriovenous fistula). For this reason, the CVC meets very often malfunction situations for intraluminal thrombotic events. The malfunction of the CVC is directly related to the duration of use, for a higher probability of thrombotic affixing on the inner wall with the passage of time. However, some patients show that they are prepared to meet very early in the CVC occlusive events, probably due to altered Hemorheological situations, not always clearly defined.
In the case of thrombotic occlusion of the CVC is sweeping the use of thrombolytic agents to try to ricanalizzarli. Among the various substances being used for the urokinase thrombolytic there is, even if the bleeding risk potentially related to its use has hampered the use on a large scale.
Aims
We conducted a retrospective case series of patients on hemodialysis with CVCs pertaining to a single dialysis center over the past 15 years, from 2001 to 2016, analyzing the effectiveness of the use of urokinase for 'declotting' of CVC for hemodialysis and the manner of its use, in the search for better therapeutic efficacy with the lowest risk of adverse events.
Methods
We have analyzed 48 cases of patients with CVC, inserted in 35 patients, for whom it was deemed appropriate to proceed with declotting urokinase due to malfunction for thrombotic occlusion. Even in our series, despite the routine filling of the lumen of the catheter with heparin sodium or sodium citrate between a dialysis and the next, the thrombotic complication of the CVC was very common, affecting in time 27% of the CVC. Our usual therapeutic protocol for the declotting of the CVC with urokinase included the following steps 1) slow-fill with positive pressure of each lumen of the CVC with a solution of 25,000 IU / ml of urokinase, by reason of the priming volume indicated by the manufacturer of the CVC and reported in writing on the same; 2) wait / bus station 30 minutes, carefully avoiding the marketing of the drug circle; 3) the total intake of the luminal contents and a few ounces of blood; 4) at a high pressure irrigation with saline solution.
Results
In our experience, 75% (36/48) of cases of CVC occluded by thrombosis were already passed on successfully with urokinase. We detected in some cases the need for repeated short-term treatment of thrombolytic therapy with urokinase, in subjects in which the position of the tip and or the side holes of the catheter had assumed a decubitus position on the vessel wall in which the CVC was allocated. In these people, the success rate of the individual thrombolytic treatment resulted however very high.
Conclusion
In our series, the unblocking of the CVC for hemodialysis with thrombolytic therapy using urokinase has proved very effective, without being burdened by any adverse reactions and / or side effects related to treatment.
Session topic: E-poster
Keyword(s): Fibrinolysis, Thrombosis
Type: Publication Only
Background
The need to use the CVC (central venous catheter) for hemodialysis is an occurrence in growth, related to the aging of the population on dialysis and the high prevalence of the disease and thrombotic angiosclerotica-uremic coaugulativa of the subject. The CVC is almost always a second best solution precisely in those subjects with situations of vascular compromise and / or coagulation disorder that does not allow the creation of the FAV (arteriovenous fistula). For this reason, the CVC meets very often malfunction situations for intraluminal thrombotic events. The malfunction of the CVC is directly related to the duration of use, for a higher probability of thrombotic affixing on the inner wall with the passage of time. However, some patients show that they are prepared to meet very early in the CVC occlusive events, probably due to altered Hemorheological situations, not always clearly defined.
In the case of thrombotic occlusion of the CVC is sweeping the use of thrombolytic agents to try to ricanalizzarli. Among the various substances being used for the urokinase thrombolytic there is, even if the bleeding risk potentially related to its use has hampered the use on a large scale.
Aims
We conducted a retrospective case series of patients on hemodialysis with CVCs pertaining to a single dialysis center over the past 15 years, from 2001 to 2016, analyzing the effectiveness of the use of urokinase for 'declotting' of CVC for hemodialysis and the manner of its use, in the search for better therapeutic efficacy with the lowest risk of adverse events.
Methods
We have analyzed 48 cases of patients with CVC, inserted in 35 patients, for whom it was deemed appropriate to proceed with declotting urokinase due to malfunction for thrombotic occlusion. Even in our series, despite the routine filling of the lumen of the catheter with heparin sodium or sodium citrate between a dialysis and the next, the thrombotic complication of the CVC was very common, affecting in time 27% of the CVC. Our usual therapeutic protocol for the declotting of the CVC with urokinase included the following steps 1) slow-fill with positive pressure of each lumen of the CVC with a solution of 25,000 IU / ml of urokinase, by reason of the priming volume indicated by the manufacturer of the CVC and reported in writing on the same; 2) wait / bus station 30 minutes, carefully avoiding the marketing of the drug circle; 3) the total intake of the luminal contents and a few ounces of blood; 4) at a high pressure irrigation with saline solution.
Results
In our experience, 75% (36/48) of cases of CVC occluded by thrombosis were already passed on successfully with urokinase. We detected in some cases the need for repeated short-term treatment of thrombolytic therapy with urokinase, in subjects in which the position of the tip and or the side holes of the catheter had assumed a decubitus position on the vessel wall in which the CVC was allocated. In these people, the success rate of the individual thrombolytic treatment resulted however very high.
Conclusion
In our series, the unblocking of the CVC for hemodialysis with thrombolytic therapy using urokinase has proved very effective, without being burdened by any adverse reactions and / or side effects related to treatment.
Session topic: E-poster
Keyword(s): Fibrinolysis, Thrombosis
Abstract: PB2203
Type: Publication Only
Background
The need to use the CVC (central venous catheter) for hemodialysis is an occurrence in growth, related to the aging of the population on dialysis and the high prevalence of the disease and thrombotic angiosclerotica-uremic coaugulativa of the subject. The CVC is almost always a second best solution precisely in those subjects with situations of vascular compromise and / or coagulation disorder that does not allow the creation of the FAV (arteriovenous fistula). For this reason, the CVC meets very often malfunction situations for intraluminal thrombotic events. The malfunction of the CVC is directly related to the duration of use, for a higher probability of thrombotic affixing on the inner wall with the passage of time. However, some patients show that they are prepared to meet very early in the CVC occlusive events, probably due to altered Hemorheological situations, not always clearly defined.
In the case of thrombotic occlusion of the CVC is sweeping the use of thrombolytic agents to try to ricanalizzarli. Among the various substances being used for the urokinase thrombolytic there is, even if the bleeding risk potentially related to its use has hampered the use on a large scale.
Aims
We conducted a retrospective case series of patients on hemodialysis with CVCs pertaining to a single dialysis center over the past 15 years, from 2001 to 2016, analyzing the effectiveness of the use of urokinase for 'declotting' of CVC for hemodialysis and the manner of its use, in the search for better therapeutic efficacy with the lowest risk of adverse events.
Methods
We have analyzed 48 cases of patients with CVC, inserted in 35 patients, for whom it was deemed appropriate to proceed with declotting urokinase due to malfunction for thrombotic occlusion. Even in our series, despite the routine filling of the lumen of the catheter with heparin sodium or sodium citrate between a dialysis and the next, the thrombotic complication of the CVC was very common, affecting in time 27% of the CVC. Our usual therapeutic protocol for the declotting of the CVC with urokinase included the following steps 1) slow-fill with positive pressure of each lumen of the CVC with a solution of 25,000 IU / ml of urokinase, by reason of the priming volume indicated by the manufacturer of the CVC and reported in writing on the same; 2) wait / bus station 30 minutes, carefully avoiding the marketing of the drug circle; 3) the total intake of the luminal contents and a few ounces of blood; 4) at a high pressure irrigation with saline solution.
Results
In our experience, 75% (36/48) of cases of CVC occluded by thrombosis were already passed on successfully with urokinase. We detected in some cases the need for repeated short-term treatment of thrombolytic therapy with urokinase, in subjects in which the position of the tip and or the side holes of the catheter had assumed a decubitus position on the vessel wall in which the CVC was allocated. In these people, the success rate of the individual thrombolytic treatment resulted however very high.
Conclusion
In our series, the unblocking of the CVC for hemodialysis with thrombolytic therapy using urokinase has proved very effective, without being burdened by any adverse reactions and / or side effects related to treatment.
Session topic: E-poster
Keyword(s): Fibrinolysis, Thrombosis
Type: Publication Only
Background
The need to use the CVC (central venous catheter) for hemodialysis is an occurrence in growth, related to the aging of the population on dialysis and the high prevalence of the disease and thrombotic angiosclerotica-uremic coaugulativa of the subject. The CVC is almost always a second best solution precisely in those subjects with situations of vascular compromise and / or coagulation disorder that does not allow the creation of the FAV (arteriovenous fistula). For this reason, the CVC meets very often malfunction situations for intraluminal thrombotic events. The malfunction of the CVC is directly related to the duration of use, for a higher probability of thrombotic affixing on the inner wall with the passage of time. However, some patients show that they are prepared to meet very early in the CVC occlusive events, probably due to altered Hemorheological situations, not always clearly defined.
In the case of thrombotic occlusion of the CVC is sweeping the use of thrombolytic agents to try to ricanalizzarli. Among the various substances being used for the urokinase thrombolytic there is, even if the bleeding risk potentially related to its use has hampered the use on a large scale.
Aims
We conducted a retrospective case series of patients on hemodialysis with CVCs pertaining to a single dialysis center over the past 15 years, from 2001 to 2016, analyzing the effectiveness of the use of urokinase for 'declotting' of CVC for hemodialysis and the manner of its use, in the search for better therapeutic efficacy with the lowest risk of adverse events.
Methods
We have analyzed 48 cases of patients with CVC, inserted in 35 patients, for whom it was deemed appropriate to proceed with declotting urokinase due to malfunction for thrombotic occlusion. Even in our series, despite the routine filling of the lumen of the catheter with heparin sodium or sodium citrate between a dialysis and the next, the thrombotic complication of the CVC was very common, affecting in time 27% of the CVC. Our usual therapeutic protocol for the declotting of the CVC with urokinase included the following steps 1) slow-fill with positive pressure of each lumen of the CVC with a solution of 25,000 IU / ml of urokinase, by reason of the priming volume indicated by the manufacturer of the CVC and reported in writing on the same; 2) wait / bus station 30 minutes, carefully avoiding the marketing of the drug circle; 3) the total intake of the luminal contents and a few ounces of blood; 4) at a high pressure irrigation with saline solution.
Results
In our experience, 75% (36/48) of cases of CVC occluded by thrombosis were already passed on successfully with urokinase. We detected in some cases the need for repeated short-term treatment of thrombolytic therapy with urokinase, in subjects in which the position of the tip and or the side holes of the catheter had assumed a decubitus position on the vessel wall in which the CVC was allocated. In these people, the success rate of the individual thrombolytic treatment resulted however very high.
Conclusion
In our series, the unblocking of the CVC for hemodialysis with thrombolytic therapy using urokinase has proved very effective, without being burdened by any adverse reactions and / or side effects related to treatment.
Session topic: E-poster
Keyword(s): Fibrinolysis, Thrombosis
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