Use of tissue plasminogen activator in obstructed peritoneal dialysis catheters

Fibrinous obstruction of a dialysis catheter is one of the major complications encountered with peritoneal dialysis (PD). Due to the removal of urokinase 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 feasible substitution. We propose a regimen of tPA use in obstructed PD catheters to restore catheter patency. Three case reports are presented in which tPA was utilized in an attempt to salvage peritoneal catheter function. The 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 itself. The dwell time that was used initially was 20 min. With the first attempt at fibrinolysis, catheter patency was not achieved; therefore, revisions in the protocol were made based on the drug's pharmacokinetic properties. The new protocol, which increased the dwell time to 1 hr, was successful in the subsequent 3 instillations. In conclusion, tPA provides an effective treatment option for obstructed PD catheters. The treatment was tolerated well by the patients, and catheter function was restored in 100% of the patients using the protocol outlined.