Tissue plasminogen activator can effectively declot peritoneal dialysis catheters

Sahani, Mandeep; Mukhtar, Kunwer Naveed; Boorgu, R; Leehey, David J.; Popli, Subhash; Ing, Todd S.

doi:10.1053/ajkd.2000.16212

Cited by 15 publications

(8 citation statements)

References 2 publications

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“…Referenced and related citations were also searched for pertinent literature. The search resulted in 1 open-label pilot study, 16 3 case series, 5,17,18 and 2 case reports [19][20] of alteplase use in declotting occluded PD catheters. In many of these reports, the dose, volume, and dwell times of alteplase varied greatly.…”

Section: Literature Reviewmentioning

confidence: 99%

“…12–15 Later, alteplase (t-PA) was used in place of urokinase during a period of urokinase unavailability. 16–20…”

mentioning

confidence: 99%

“…[12][13][14][15] Later, alteplase (t-PA) was used in place of urokinase during a period of urokinase unavailability. [16][17][18][19][20] Alteplase is a tissue recombinant protease specific for fibrin that was approved by the US Food and Drug Administration (FDA) for several indications, including the restoration of function to central venous access devices. 21 The dose used for catheter clearance is much lower than that used for systemic thrombolysis.…”

mentioning

confidence: 99%

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Use of Alteplase for Clearing Peritoneal Dialysis Catheter Occlusion

Pierce

2016

Hosp Pharm

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Background Peritoneal dialysis (PD) catheter complications account for 20% of all transfers from PD to hemodialysis. One complication is outflow obstruction caused by fibrin deposits within the lumen of the catheter. Alteplase is frequently used to clear fibrin deposits in PD catheters that are refractory to other therapies. However, the literature basis for this practice is unclear. Method A review of the literature was conducted to determine the evidence existing for alteplase use in PD catheter occlusion due to fibrin. A literature search of MEDLINE (1967-present) was conducted using the search terms “alteplase”, “peritoneal dialysis catheter”, “occlusion”, “fibrin”, and “tissue plasminogen activator”. Referenced citations were also searched for pertinent material. All data concerning the use of alteplase for peritoneal dialysis catheter occlusion were included in this review. The search resulted in 1 open-label pilot study, 3 case series, and 2 case reports of alteplase use in declotting occluded PD catheters. Results Based on the data, alteplase therapy cleared the occlusion of PD catheters in the majority of cases. In those that were unsuccessful, other surgically correctable and mechanical causes were identified in most cases. Conclusion Alteplase appears to be an intriguing alternative to the surgical removal of the PD catheter in patients with catheter occlusion due to fibrin. Although not inexpensive, it appears safe and may decrease the need for surgical correction of occluded catheters.

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Section: Literature Reviewmentioning

confidence: 99%

“…12–15 Later, alteplase (t-PA) was used in place of urokinase during a period of urokinase unavailability. 16–20…”

mentioning

confidence: 99%

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confidence: 99%

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Use of Alteplase for Clearing Peritoneal Dialysis Catheter Occlusion

Pierce

2016

Hosp Pharm

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“…Intraluminal obstruction due to blood clots or fibrin plugs may respond to manual compression of the dialysis bag or aspiration and forceful flushing with heparinized saline [192]. The use of fibrinolytic agents such as urokinase or TPA followed by forceful irrigation is also an option to remove clots and fibrin plugs in both adults and children [201][202][203]. Two publications report restoration of catheter function in 57 and 83 %, respectively [204,205].…”

Section: Nonoperative Managementmentioning

confidence: 99%

Guidelines for laparoscopic peritoneal dialysis access surgery

et al. 2014

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“…If it does not restore fl ow, the instillation of fi brinolytic agents may be tried. The use of recombinant plasminogen tissue activator (rt-PA) showed to be effective in restoring catheters fl ow [67][68][69]. In a study with 29 cases of obstruction, a mixture of 8 mg of rt-PA in 10 ml of sterile water was injected into the catheter and allowed to dwell for 1 h. A patency was restored in 24 of 29 instances with no adverse effects [69].…”

Section: Late Dysfunctionmentioning

confidence: 99%

Complications of the Peritoneal Access and Their Management

Campos

Chula

Riella

2009

Peritoneal Dialysis - From Basic Concepts to Clinical Excellence

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Although peritoneal catheter insertion is relatively considered a minimal invasive procedure, it is associated with some complications. These complications are divided into mechanical (bleeding, visceral perforation, dialysate leaks, catheter dysfunction, hernia formation, cuff extrusion) and infectious (early peritonitis, surgical wound, tunnel and exit site infections). It is well recognized that the appearance of these complications can increase morbidity and the chance of peritoneal dialysis treatment failure. Independent of the insertion technique, the operator must be prepared to an immediate recognition and adequate management of complications. Pre-operative evaluation and identification of potential risk factors are essential to prevent them.

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Tissue plasminogen activator can effectively declot peritoneal dialysis catheters

Cited by 15 publications

References 2 publications

Use of Alteplase for Clearing Peritoneal Dialysis Catheter Occlusion

Use of Alteplase for Clearing Peritoneal Dialysis Catheter Occlusion

Guidelines for laparoscopic peritoneal dialysis access surgery

Complications of the Peritoneal Access and Their Management

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