In Reply to: Re: 597 04 -- Catheter-related SVC thrombosis posted by LY SING QUICKLY, MD on August 12, 1997 at 21:17:46:
I definitely have no sure answer for this, but we have used a similar system with some success. Unfortunately, we usually get called at the end of the day after the patient has been sitting in dialysis with them trying all kinds of positions, switching ports, etc. with poor results. They don't consult us until the day is almost up. We got tired of launching into these kinds of cases at the end of the day, so have began doing this: get CXR to make sure the catheters (we use Tesios) are not kinked, pulled back, flipped into azygous, etc. Then we try to aspirate and inject under flouro to see if it's a fibrin sheath or "big" clot. If it's fibrin sheath, I inject 125K of UK plus 2,000 units of heparin into each of two ports. The patient goes home and *nobody* touches the catheters until the next morning in dialysis. The success is similar to yours. If there's a "significant" clot around the catheter, they are admitted and undergo continuous infusion (usually 40k to 60k/hr in each of two ports) with followup venography in AM and catheter exchange if necessary. Basically, I try to avoid exchange if I can. I have not, however, tried exchanging through the old tunnel. I am encouraged by the results of others and may try this way instead.