Switch the heparin infusion to the systemic IV during follow-up venography in order to prevent decrease in the plasma level while the patient is in Radiology. Keep the patient well hydrated during urokinase infusions. This will protect from toxicity related to serial contrast studies. A foley catheter is placed in all patients depending on the patient's ability to void in a recumbent position. If a femoral approach is concomitantly used, a foley is placed.
Optimal hydration seems to favor resolution of thrombus.
Laboratory studies are performed every 4-6 hours. Longer intervals are discouraged early in the case. We demand pediatric amounts be drawn and request re-infusion of any blood withdrawn to clear the line. This will minimize decrease in hemoglobin secondary to phlebotomy. On a periodic basis, hemoglobin platelets and fibrinogen are checked.