Tissue plasminogen activator infusion as a treatment for hemodialysis catheter dysfunction

Abstract

AbstractBACKGROUNDThe formation of a fibrin sheath thrombus is the most common cause of hemodialysis catheter dysfunction (HCD). The infusion of a low‐dose recombinant tissue plasminogen activator (rtPA) has been shown to be safe and effective. However, there is no consensus as to the optimum amount of rtPA.OBJECTIVETo evaluate the safety and efficacy of a low‐dose rtPA infusion for the treatment of fibrin sheath thrombus.METHODSWe did a retrospective review of patients with HCD who were treated with rtPA infusion between August 2006 and August 2007. Each patient had a radiographic evaluation to rule out malposition before administering 1 mg rtPA in 50 mL of normal saline over a 1‐hour period per port (total of 2 mg).RESULTSA total of 74 patients had a total of 86 infusions administered. Their mean age was 62 years, and 52% were male. The clinical success rate, defined as an ability to support at least 1 successful dialysis session, was 95.3%. No major procedure‐related complications occurred. The median catheter patency was 40.5 days.CONCLUSIONRtPA, administered at current study dose, safely and effectively restores catheter function. To our knowledge, this is the lowest dose and shortest infusion time that has been studied.