Salvaging intraluminal peritoneal dialysis catheter obstruction from blood clot with a targeted thrombolytic agent:...

Area of Science:

• Nephrology
• Gastroenterology
• Medical Device Technology

Background:

• Peritoneal dialysis (PD) catheter malfunction, often due to intraluminal blood clots, frequently necessitates catheter removal and transfer to hemodialysis.
• Standard treatments include heparinized saline irrigation, thrombolytic agents, and mechanical methods like intraluminal brushing.

Observation:

• A case presented where an intraluminal blood clot in a PD catheter persisted despite conventional thrombolytic and mechanical interventions.
• The coiled nature of the PD catheter complicated clot access and treatment.

Findings:

• A novel approach involved using an endoscopic retrograde cholangiopancreatography (ERCP) guidewire to reinforce the PD catheter and puncture the clot.
• Targeted thrombolysis was administered directly to the clot using a Swing Tip cannula, successfully dissolving the obstruction.

Implications:

• This case demonstrates a successful strategy for salvaging PD catheters with persistent intraluminal clots, potentially avoiding catheter removal and transition to hemodialysis.
• The described technique offers a viable alternative for managing complex PD catheter obstructions, preserving treatment continuity for patients.