Analysis of rt-PA infusion in tunnelled dialysis catheters

Urokinase and streptokinase are commonly used thrombolytic agents for obstructed central venous catheters. Although proven to be efficacious, these agents have the potential to induce fibrin breakdown and streptokinase cannot be used repeatedly due to its allergenic nature. Documented evidence suggests that urokinase is safe and effective (> 70% efficacy for catheter installation) however further evidence points to tissue-type plasminogen activator (rt-PA) achieving as much as 98% success. This study reports on the safety and efficacy of alternative catheter thrombolysis, namely rt-PA and evaluates the efficacy of rt-PA. 20 patients required 57 infusions in 38 lumens between 01/01/02 to 01/09/03. For completely blocked lines rt-PA was infused at 2 mg/hr for 4 hours achieving 85% success rate. For inadequate flow (< 250 mls/min) rt-PA was infused at 1 mg/hr for 4 hours achieving 88% success rate.