Use of tissue plasminogen activator in obstructed peritoneal dialysis catheters

Fibrinous obstruction of a dialysis catheter is one of the major complicati ons encountered with peritoneal dialysis (PD). Due to the removal of urokin ase from the market (because of problems in its manufacturing process), an alternative fibrinolytic agent was indicated. Tissue plasminogen activator (tPA) offered similar properties to those of urokinase and seemed to be a f easible substitution. We propose a regimen of tPA use in obstructed PD cath eters to restore catheter patency. Three case reports are presented in whic h tPA was utilized in an attempt to salvage peritoneal catheter function. T he concentration of tPA used was 1 mg/ml. The volumes were determined based upon the volume of the transfer set used plus the volume of the catheter i tself. The dwell time that was used initially was 20 min. With the first at tempt at fibrinolysis, catheter patency was not achieved; therefore, revisi ons in the protocol were made based on the drug's pharmacokinetic propertie s. The new protocol, which increased the dwell time to 1 hr, was successful in the subsequent 3 instillations. In conclusion, tPA provides an effectiv e treatment option for obstructed PD catheters. The treatment was tolerated well by the patients, and catheter function was restored in 100% of the pa tients using the protocol outlined.