Short-term continuous infusion thrombolytic therapy for occluded central venous dialysis catheters

The necessity of maintaining a strict schedule of dialysis treatments in patients with chronic renal failure dictates that occluded access catheters be restored to full function in a timely and cost-effective manner. The records of 22 consecutive patients receiving outpatient treatment for occluded hemodialysis catheters at Osteopathic Medical Center of Texas were reviewed by the authors. Each patient had 100,000 units of urokinase in 50 mi normal saline instilled over 30 minutes through the occluded catheter. In most instances the dose was divided to allow 35 mi to the proximal port and 15 mi to the distal port. The maximum sustained blood flow rate on dialysis was recorded for each patient. The mean maximum sustained blood flow rate improved from 150 ml/min +/- 79 mi to 261 ml/min +/- 62 mi. Following infusion, improvement was obtained in 19 of 22 patients, with 14 catheters delivering blood flow greater than 250 ml/min. The total cost per treatment was $316. No adverse events were experienced. Thrombotic occlusion of extended use hemodialysis catheters can be rapidly and safely relieved in a cost-effective manner with little delay in scheduled dialysis treatments.