Percutaneous fibrin sheath stripping versus transcatheter urokinase infusion for malfunctioning well-positioned tunneled central venous dialysis catheters: A prospective, randomized trial

PURPOSE: To compare central dialysis catheter patency rates after stripping procedures with those after urokinase (UK) infusion. MATERIALS AND METHODS: Fifty-seven tunneled catheters with either (i) flow rates less than 250 mL/min and established baseline flow rates greater than or equal to 300 mL/min or (ii) flow rates 50 mL/min less than higher estab lished baseline flows were prospectively randomized to undergo stripping pr ocedures (n = 28) or UK infusion (n = 29) at 30,000 U/h via each port concu rrently, for a total 250,000 U, Success and patency were determined by dial ysis at normal flow rates (greater than or equal to 300 mL/min) or at the p reviously established higher baseline rate. Flow rates were monitored weekl y. Primary patency ended with catheter malfunction or removal. Kaplan-Meier survival analysis was used to construct survival curves. RESULTS: In the stripping group, initial clinical success was 89% (25 of 28 ), The 15-, 30-, and 45-day primary patency rates were 75% (n = 20), 52% (n = 13), and 35% (n = 8), respectively. The median duration of additional fu nction was 32 days (95% CI: 18-48 d), In the UK group, initial clinical suc cess was 97% (28 of 29), The 15-, 30-, and 45-day primary patency rates wer e 86% (n = 21), 63% (n = 13), and 48% (n = 9), respectively. The median dur ation of additional patency was 42 days (95% CI: 22-153 d), The Wilcoxon te st for equality detected no significant difference in the survival curves f or the two treatment groups (P =.236), CONCLUSION: There is no significant difference in time to primary patency b etween the two methods. Both allow temporary catheter salvage in most patie nts.