Urokinase for blocked central venous access device (CWard Formulary)

INDICATION

Urokinase is the most common thrombolytic used for unblocking central lines.

Lines may be:

• completely blocked: unable to flush or withdraw.
• partially blocked: flushed but cannot bleed back.

Urokinase can be used in both scenarios.

ADMINISTRATION

Urokinase MUST be prescribed on the drug chart.

• May be repeated once, if necessary.
• For children less than 10kg: Contact consultant for advice.
• For those above 10kg: Follow the reconstitution guidance in Table 1 or 2 below.

SUPPLY

• Vials containing powder for solution for injection.
• Strength: 10,000 units (other strengths available but 10,000 units used in paediatrics).
• Use immediately. 
• Keep vial in outer container to protect from light.

Stock availability: 100,000 units has been used instead of other strengths due to stock unavailability issues.  See Table 2 for reconstitution guidance for the 100,000 unit strength.

PREPARATION

1. Reconstitute with sodium chloride 0.9% and instil the appropriate volume (see Table below) into the catheter dead space only. Lock under pressure.
2. Leave in situ for 20 to 60 minutes.
3. Aspirate using pulsing ("pull-push") method using a 10mL syringe (primed with 0.9% sodium chloride).
4. Flush with sodium chloride 0.9%.
5. If line remains blocked, urokinase may be repeated and left in line for 24 hours.
6. After 24 hours repeat step 3.  If line remains blocked, contact Child’s Lead Team/consultant.