TREATMENT OF PARTIAL OR COMPLETE OCCLUSION OF CENTRAL VENOUS CATHETERS WITH UROKINASE

Dosage

The volume of 5000 unit/ml urokinase that is required will be determined by the internal volume of catheter lumen.  This will be found in the information package with the catheter, or written on the catheter lumen.

Administration

1.       Prepare the urokinase as per manufacturers instructions.

2.       Withdraw urokinase into the 5ml syringe.

3.       Prepare the patient and catheter.

4.       Clamp catheter.

5.       Glove using sterile technique.

6.       Aseptically wipe catheter plugs with chlorhexidine.

7.       Remove plugs from catheter.

8.       Attach 5ml syringe containing urokinase to lumen of catheter.

9.       Unclamp catheter.

10.   Gently instill the urokinase into the lumen of the catheter, avoiding excessive force.  If resistance is met, use the push-pull technique to maximise the mixing in the catheter.

11.   Clamp the catheter and allow the solution to remain in the lumen for 30-60 minutes.

12.   After 30-60 minutes, attempt to aspirate the blood and solution.

13.   If patency is restored, aspirate 5ml of blood to ensure removal of the drug and clot.

14.   If patency is not restored, the solution should be left in for a further 12-24 hours wherever possible.

15.   After 12-24 hours, attempt to aspirate the solution, if patency is still not restored and the line is not useable, removal of the line needs to be considered.

Documentation

Appropriate documentation should be completed detailing firstly what steps were taken and secondly the patency of the catheter after each of these steps.