title: The use of tissue plasminogen activator infusion to re-establish function of tunneled hemodialysis catheters.
abstract: 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.
authors.affiliation: Albany Medical College, Vascular Institute for Health and Disease, Albany, NY, USA.
authors.forename: Kyran
authors.initials: K
authors.lastname: Dowling
authors.forename: Gail
authors.initials: G
authors.lastname: Sansivero
authors.forename: Brian
authors.initials: B
authors.lastname: Stainken
authors.forename: Gary
authors.initials: G
authors.lastname: Siskin
authors.forename: Eric
authors.initials: E
authors.lastname: Dolen
authors.forename: Jiyong
authors.initials: J
authors.lastname: Ahn
authors.forename: Nancy
authors.initials: N
authors.lastname: Mitchell
mesh_terms: 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*
chemical_list: D005343:Fibrinolytic Agents; D010959:Tissue Plasminogen Activator