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A prospective audit evaluating use of urokinase in oncology patients with occluded central venous access devices

24 October 2019
Thrombolytic Agents
02 October 2019
Volume 28 · Issue 19

Abstract

This article reports the results of a single-site prospective audit evaluating the safety and effectiveness of urokinase (Syner-Kinase®) to restore patency in central venous access devices (CVADs) for cancer patients. CVADs are routinely inserted to allow the safe and timely administration of systemic anti-cancer therapies; therefore, catheter dysfunction can interrupt the treatment schedule and adversely affect patient outcome. The aim was to contribute to the development of evidence-based, standardised, best practice guidelines. Prospective data were collected from all patients (n=22) identified with an occluded CVAD, requiring use of Syner-Kinase to manage a persistent withdrawal occlusion or total occlusion, over a 6-month period. Findings revealed a single administration of Syner-Kinase for catheter occlusion clearance to be effective in 92% of cases. Results suggest that use of the thrombolytic agent is well-tolerated and an effective means of restoring patency for long-term CVADs in cancer patients.

NHS England (2016) reported that over 150 000 people in the UK were receiving some form of systemic anti-cancer therapy (SACT). The increasing effectiveness of drug regimens has resulted in patients now being able to receive multiple courses of SACT over a number of years. However, it is well documented that repeated peripheral administration of intravenous (IV) anti-cancer therapies has the potential to cause significant debilitating chemical phlebitis, which can ultimately compromise a patient's treatment schedule (Moureau et al, 2012; Flynn et al, 2014; Kelly et al, 2015; Marshall-McKenna et al, 2015). As a result, various types of long-term central venous access devices (CVADs) are now routinely inserted to allow the safe and timely administration of IV SACT (Bertoglio et al, 2016; Harrold et al, 2016; Kelly, 2017; Ryan et al, 2018; Campagna et al, 2019). These include: cuffed tunnelled central catheters (Hickman lines), peripherally inserted central catheters (PICCs) and totally implanted CVADs (ports).

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Central venous access device
Catheter occlusion
Urokinase
Thrombolytic
Oncology
Systemic anti-cancer therapy