| Statement |
Persistent Withdrawal Occlusion (PWO) can be described as the inability to withdraw blood via the catheter while retaining the capacity to infuse solutions without difficulty.
The main significance of PWO is that the practitioner cannot be certain that the catheter is in the correct position when there is no free-flowing blood return. A satisfactory blood return is the verification that the catheter is in a vein and that the catheter is functioning correctly prior to any intravenous therapy. |
| Troubleshooting |
Before proceeding with Urokinase administration check the following:
- Withdrawal of blood and flushing has already been attempted (see appropriate templates).
- No kinks/clamps occluding the catheter.
- Ask the patient to take a deep breath in and hold whilst attempting to aspirate the catheter.
- Try altering the position of the arm and/or 30° head down tilt.
- If clamps are present, move clamp further down the catheter then roll the previously clamped section in your fingers gently to ensure that the catheter walls are not ‘stuck together.’
- Prior to administering Urokinase, an x-ray may be obtained to verify the correct position of the catheter in a blood vessel.
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| Requirements |
- PPE (minimal consideration of gloves and aprons)
- Clean tray or trolley
- Sterile dressing pack
- 10ml luer lock syringes
- IV 0.9% Sodium Chloride (NaCl) amp(s) (appropriate volume for patient and VAD)
- Catheter lock -volume as guided by size of catheter (*refer to local SOPs and manufacturer recommendations for exact volume)
- Curos cap (disinfection cap) (x1 per lumen)
- 21g safety hypodermic needle or 18G blunt filter needle
- 2% chlorhexidine in 70% isopropyl alcohol wipe/wand (0.5% chlorhexidine in 70% isopropyl alcohol is recommended as an alternative for babies less than 3 months old)
- Urokinase solution
- Clinical waste bag
- Sharps bin.
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| Timing |
This should be conducted in a hospital environment and must always be prescribed. |
| Procedure |
- Explain the process to the child and parent and gain consent.
- Perform hand hygiene.
- Clean trolley/tray with disinfectant wipes.
- Open sterile dressing pack. Using ANTT, assemble equipment onto the sterile field.
- Perform hand hygiene.
- Apply PPE.
- Using a 10ml syringe, reconstitute the Urokinase as per Medusa NHS Injectable Medicines Guide.
- Place the sterile drape under the CVAD to create a sterile field.
- ‘Scrub the hub’ of needle free access device with 2% chlorhexidine in 70% isopropyl alcohol wipe for at least 30 seconds and allow to dry
- Connect 10ml syringe filled with Urokinase to the needle free access device and using push pause technique to deliver the 2 ml solution. Repeat for all lumens. If the catheter has an external clamp this should be left unclamped while the Urokinase lock is in situ.
- Discard all disposable equipment.
- Remove PPE and discard as healthcare waste.
- Perform hand hygiene.
- Leave the Urokinase in situ for 1-4 hours, and then withdraw the Urokinase lock.
To withdraw Urokinase lock: Using ANTT, attach a sterile 10ml syringe attempt to withdraw blood.
If unsuccessful, this process can be repeated a further once in 24 hours.
Practitioners may consider leaving Urokinase in situ for a period of 12 to 24 hours. This must be done with consultation of medical teams and the patient must remain as an inpatient for this period.
If successful, discard aspirated blood-stained fluid and flush then lock line (if required). |
| Aftercare |
Record in patient notes and CVAD bundle.
Ongoing care and maintenance should be undertaken. |
NHS Ayrshire & Arran guidelines
