Efficacy of tissue plasminogen activator administration on patency of hemodialysis access catheters

Patients with end-stage renal disease use hemodialysis catheters for either temporary or permanent blood access. Recurrent thrombosis and fibrin sheat h formation are common causes of poor or inadequate blood flow rates that r equire intervention. We studied the effect of tissue plasminogen activator (tPA) in reestablishing adequate blood flow rates through nonfunctional vas cular catheters in 22 consecutive chronic hemodialysis patients. From Janua ry 1, 1999, to May 20, 1999, there were 56 instances in which tPA was used in an attempt to improve blood flow rates. In all instances, 2 mg of tPA wa s infused into each port of a dual-lumen internal jugular catheter. Dwell t ime ranged between 2 and 96 hours (median, 24 hours), and patient follow-up ranged between 47 and 140 days (median, 133.5 days), tPA was effective in establishing adequate blood flow rates (greater than or equal to 200 mL/min ) during the next dialysis session in 49 of 56 cases (87.5%). Seven additio nal interventions were required because of early or late tPA failure (one f ibrin sheath stripping, one catheter replacement for kinking, one catheter replacement for central venous stenosis, and four catheter replacements for persistently poor blood flow rates), and eight catheters were replaced for infection. Thus, further interventions to achieve adequate blood flow rate s were required in 12.5% of the cases because of early or late tPA failure, tPA appears to be as effective as urokinase for reestablishing adequate bl ood flow rates through hemodialysis catheters that are thrombosed or have l ow blood flow rates. (C) 2000 by the National Kidney Foundation, Inc.