Urokinase with blocked central venous access device (Paediatric Guidelines)

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. Note - urokinase will only work on blood related occlusions. If it does not work it may be due to drug precipitate. Urokinase must be prescribed on the drug chart.

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.

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 24hrs
6. After 24hrs repeat step 3. If line remains blocked contact Child’s Lead Team/Consultant

Administration 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 below.