title: Analysis of rt-PA infusion in tunnelled dialysis catheters.
abstract: Urokinase and streptokinase are commonly used thrombolytic agents for obstructed central venous catheters. Although proven to be efficacious, these agents have the potential to induce fibrin breakdown and streptokinase cannot be used repeatedly due to its allergenic nature. Documented evidence suggests that urokinase is safe and effective (> 70% efficacy for catheter installation) however further evidence points to tissue-type plasminogen activator (rt-PA) achieving as much as 98% success. This study reports on the safety and efficacy of alternative catheter thrombolysis, namely rt-PA and evaluates the efficacy of rt-PA. 20 patients required 57 infusions in 38 lumens between 01/01/02 to 01/09/03. For completely blocked lines rt-PA was infused at 2 mg/hr for 4 hours achieving 85% success rate. For inadequate flow (< 250 mls/min) rt-PA was infused at 1 mg/hr for 4 hours achieving 88% success rate.
authors.affiliation: Renal Unit, Wirral Hospital NHS Trust, Merseyside, UK.
authors.forename: J
authors.initials: J
authors.lastname: Davies
authors.forename: J
authors.initials: J
authors.lastname: Casey
authors.forename: C
authors.initials: C
authors.lastname: Li
authors.forename: A V
authors.initials: AV
authors.lastname: Crowe
authors.forename: P
authors.initials: P
authors.lastname: McClelland
mesh_terms: D000465:Algorithms; D002405:Catheterization, Central Venous / Q000009:adverse effects*; D002408:Catheters, Indwelling / Q000009:adverse effects*; D002985:Clinical Protocols; D003663:Decision Trees; D004868:Equipment Failure; D005343:Fibrinolytic Agents / Q000627:therapeutic use*; D006801:Humans; D007262:Infusions, Intravenous; D006435:Renal Dialysis / Q000295:instrumentation*; D012189:Retrospective Studies; D013927:Thrombosis / Q000209:etiology / Q000517:prevention & control*; D013997:Time Factors; D010959:Tissue Plasminogen Activator / Q000627:therapeutic use*; D016896:Treatment Outcome; D014654:Vascular Patency
chemical_list: D005343:Fibrinolytic Agents; D010959:Tissue Plasminogen Activator