Clot lysis for thrombosed central venous catheters in pediatric patients

Central venous catheters (CVC) in pediatric patients provide a reliable method for administration of total parenteral nutrition and chemotherapy. Catheter thrombotic occlusion is a major complication and, until recently, the only therapeutic option was removal and surgical replacement of the catheter. Two fibrinolytic agents, streptokinase and urokinase, have been used successfully in adults to dissolve the clots. Few side effects have been reported when these agents were administered for this purpose. The Physician's Desk Reference advises against the use of such agents in the pediatric population. However, several reports of successful use of these agents in pediatric patients have been reported. They have also been infused systemically to relieve both arterial and venous thrombi. We prospectively evaluated the safety and efficacy of thrombolytic drugs in infants and children with CVCs who were receiving parenteral nutrition and/or hemodialysis. Abbokinase was used on 14 occasions to unclot silastic catheters in 10 pediatric patients. All catheters restored to patency were cleared within 50 minutes with an average clearance time of 19.3 minutes. Only one catheter could not be salvaged. Protime levels were obtained whenever possible before and after administration of the abbokinase. No significant elevations were noted after abbokinase administration. No allergic reactions or other complications occurred. Abbokinase was found to clear clotted central lines in a shorter time frame than has previously been reported in this patient population.