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Pulmonary embolism after local urokinase instillation in a Hickman catheter

Bone Marrow Transplantation volume 28, pages 112–113 (2001)Cite this article

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Local instillation of fibrinolytic agents is a method widely used for restoring permeability of malfunctioning central catheters. We present the case of a documented episode of subsegmental pulmonary embolism complicating this procedure.

After mechanical problems have been ruled out by fluoroscopic examination, local instillation of low-dose fibrinolytic agents is a widely recommended method of restoring permeability of central catheters. It is generally considered safe and feasible on an outpatient basis.1,2 Pulmonary embolism related to this procedure or to catheter flushing has been cited as a theoretically possible complication.1,3 but no clinical description of a documented case has been published. Peripheral embolization is a widely described complication of full fibrinolytic therapy for arterial occlusion,4 and severe pulmonary embolism is a rare complication of thrombolytic therapy for venous thrombosis.5 In one study, intraluminal clots were discovered in as many as 30% of blood samples withdrawn from daily heparin-flushed Hickman catheters.3 In our view, embolization of small clots dislodged from the lumen or the tip of the catheter after urokinase sealing constitutes the most feasible explanation for this case. The chances of this complication occurring must be appropriately balanced against the proven benefits of urokinase instillation.

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References

  1. Alexander HR . Vascular access and specialized techniques of drug delivery In: DeVita VT, Hellman S, Rosenberg SA (eds) Cancer: Principles and Practice of Oncology 5th edn Philadelphia: Lippincott-Raven Publishers 1997 pp 725–734

    Google Scholar 

  2. Weisdorf SS, Schwarzenberg SJ . Nutritional support of hematopoietic stem cell recipients In: Thomas ED, Blume KG, Forman SJ (eds) Hematopoietic Cell Transplantation 2nd edn Blackwell Science: Malden 1998 pp 723–732

    Google Scholar 

  3. Johnston A, Krasnow SH, Boyer MW et al. Hickman catheters clots: A common occurrence despite daily heparin flushing Cancer Treat Rep 1987 71: 651–653

    Google Scholar 

  4. Earnshaw JJ, Hopkinson BR, Makin GS . Cerebral embolus as a complication of streptokinase therapy Clin Radiol 1985 36: 658

    Article  CAS  Google Scholar 

  5. Gajewski J . Thrombolytic therapy and fatal massive pulmonary emboli Ann Intern Med 1971 74: 450

    CAS  PubMed  Google Scholar 

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  1. Department of Oncology and Service of Haematology, Cell Therapy Area, Clínica Universitaria de Navarra, Pío XII 36, Pamplona, 31008, Spain

    J Pérez-Calvo, M Santisteban, JM López-Picazo & S Martín-Algarra

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  1. J Pérez-Calvo
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  2. M Santisteban
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  3. JM López-Picazo
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  4. S Martín-Algarra
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Pérez-Calvo, J., Santisteban, M., López-Picazo, J. et al. Pulmonary embolism after local urokinase instillation in a Hickman catheter. Bone Marrow Transplant 28, 112–113 (2001). https://doi.org/10.1038/sj.bmt.1703091

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