The use of tissue plasminogen activator infusion to re-establish function of tunneled hemodialysis catheters.
OBJECTIVE
To evaluate the safety and efficacy of the recombinant tissue plasminogen activator alteplase in the clearance of poorly functioning tunneled hemodialysis catheters.


METHODS
We retrospectively reviewed the outcomes of 25 patients who presented with poorly functioning hemodialysis catheters and were treated with alteplase. After confirming fluoroscopically the need for thrombolytic therapy, alteplase was administered over 2 hours as a 2.5-mg/hour/catheter lumen infusion (total 10 mg). Treatment was considered a clinical success if a flow rate of 250 mL or more per minute was established.


RESULTS
Clinical success was achieved in each of 25 patients (100%). There were no thrombolytic-related complications. Catheter survival was extended 30 days in 54% of patients and 45 days in 33% of patients.


CONCLUSIONS
Alteplase is a safe and effective means of producing clearance of blocked tunneled catheters.
Dowling
Kyran
K
Albany Medical College, Vascular Institute for Health and Disease, Albany, NY, USA.
Sansivero
Gail
G
Stainken
Brian
B
Siskin
Gary
G
Dolen
Eric
E
Ahn
Jiyong
J
Mitchell
Nancy
N
D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D002408:Catheters, Indwelling; D004868:Equipment Failure; D005260:Female; D005343:Fibrinolytic Agents / Q000627:therapeutic use*; D006801:Humans; D008297:Male; D008875:Middle Aged; D006435:Renal Dialysis / Q000295:instrumentation*; D012189:Retrospective Studies; D012449:Safety; D010959:Tissue Plasminogen Activator / Q000627:therapeutic use*
D005343:Fibrinolytic Agents; D010959:Tissue Plasminogen Activator