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Updated: Jul 20, 2026

Prehospital Thrombolysis: A Manual from Berlin
05:52

Prehospital Thrombolysis: A Manual from Berlin

Published on: November 26, 2013

A patient-focused approach to thrombolytic use in the management of catheter malfunction

Charmaine E Lok1, Alison Thomas, Lavern Vercaigne

  • 1University Health Network-Toronto General Hospital and the University of Toronto, Toronto, Ontario, Canada. charmaine.lok@uhn.on.ca

Seminars in Dialysis
|September 15, 2006
PubMed

Insights

Thrombolytic agents (TLAs) are key for dialysis catheter malfunction. This review categorizes TLA use for acute or rescue therapy, proposing a new management algorithm for improved patient outcomes.

Area of Science:

  • Nephrology
  • Vascular Access Management
  • Pharmacology

Background:

  • Thrombus formation frequently causes dialysis catheter malfunction.
  • Local luminal installation of thrombolytic agents (TLAs) is the primary treatment.
  • Existing TLA protocols lack standardized clinical application guidelines.

Purpose of the Study:

  • To systematically review thrombolytic agent protocols for dialysis catheter malfunction.
  • To categorize TLA administration based on clinical urgency (acute vs. rescue therapy).
  • To propose a unifying, clinically relevant management algorithm for TLA use.

Main Methods:

  • Systematic literature review of PubMed and EMBASE databases (inception to August 2005).
  • Categorization of TLA protocols by clinical need: acute malfunction or rescue therapy.
  • Development of a management algorithm based on literature synthesis.

Main Results:

  • Identified three major TLA installation methodologies: locking, push, and infusion.
  • Differentiated TLA application for acute needs (dialysis initiation) versus rescue therapy (maintaining clearance).
  • Proposed a novel algorithm integrating etiology and clinical presentation for TLA selection.

Conclusions:

  • A structured approach to TLA use, guided by a new algorithm, can optimize dialysis catheter management.
  • The proposed algorithm requires prospective validation to confirm its clinical utility.
  • Standardizing TLA protocols can improve treatment efficacy for thrombus-related catheter dysfunction.

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