Weekly prophylactic urokinase instillation in tunneled central venous access devices

PURPOSE: To determine the safety and efficacy of weekly prophylactic urokin ase therapy in tunneled central venous access devices (VADs). MATERIALS END METHODS: A prospective, randomized study was performed in 105 ; patients who underwent tunneled VAD placement between March 1997 and Apri l 1998, The patients were randomized to receive either twice-daily heparin flushes (14 heparin flushes per week; group A, n = 52) or twice-daily hepar in flushes with once-weekly urokinase (UK) instillation (13 heparin flushes , one UK flush per week; group B, n = 53), Patients were followed up by exa mination and/or interview at 1, 3, and 6 months for signs and symptoms of d elayed catheter-related complications. RESULTS: The total number of indwelling catheter-days was similar between g roups (5,450 in group A, 5,276 in group B), The total number of infectious complications and fibrin sheaths formed was greater for group A (n = 11; 21 .1%) than group B (n = 3; 5.7%) (P = .02), There were no side effects noted from the prophylactic UK administrations. CONCLUSION: Prophylactic UR is advantageous in preventing delayed catheter- related complications.