Why the study?
Does a protocol of aspirin, warfarin, and urokinase maintain the patency of double-lumen silastic jugular catheters in hemodialysis patients?
Does a protocol of aspirin, warfarin, and urokinase maintain the patency of double-lumen silastic jugular catheters in hemodialysis patients?
A protocol using aspirin, warfarin, and urokinase can successfully maintain patency of jugular hemodialysis catheters, though bleeding risks require close monitoring.
May aid hemodialysis catheter patency with bleeding monitoring; leaves open randomized confirmation of this protocol.
A system has been developed for maintaining the patency of double lumen silastic jugular catheters in patients with refractory vascular access problems. Most patients receive a small daily dose of aspirin. Selected patients also receive warfarin to maintain a prothrombin time (PT) of 15, 20, or 30 seconds. Inadequate blood flow due to thrombus obstruction can be overcome by the intravenous administration of urokinase, 250.000 units. This can be administered safely to outpatients provided that heparin is not given simultaneously. Occasionally a second dose may be required. By adopting this policy all catheter obstructions have been overcome. The danger of iatrogenic bleeding cannot be discounted. Warfarin therapy must be very closely monitored.
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Uldall et al. (1993) studied this question.
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