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 established baseline flows were prospectively randomized to undergo stripping procedures (n = 28) or UK infusion (n = 29) at 30,000 U/h via each port concurrently, for a total 250,000 U, Success and patency were determined by dialysis at normal flow rates (greater than or equal to 300 mL/min) or at the previously established higher baseline rate. Flow rates were monitored weekly. 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 function was 32 days (95% CI: 18-48 d), In the UK group, initial clinical success was 97% (28 of 29), The 15-, 30-, and 45-day primary patency rates were 86% (n = 21), 63% (n = 13), and 48% (n = 9), respectively. The median duration of additional patency was 42 days (95% CI: 22-153 d), The Wilcoxon test for equality detected no significant difference in the survival curves for the two treatment groups (P =.236), CONCLUSION: There is no significant difference in time to primary patency between the two methods. Both allow temporary catheter salvage in most patients.