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11 Thrombolysis of Permanent Hemodialysis Catheters
Author(s) -
Premru V
Publication year - 2005
Publication title -
therapeutic apheresis and dialysis
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 0.415
H-Index - 53
eISSN - 1744-9987
pISSN - 1744-9979
DOI - 10.1111/j.1526-0968.2005.222_11_11.x
Subject(s) - medicine , thrombolysis , urokinase , catheter , hemodialysis catheter , surgery , hemodialysis , dialysis catheter , occlusion , heparin , jugular vein , anesthesia , myocardial infarction , cardiology
Outline Occlusion of hemodialysis (HD) catheter and infection are by far the most frequent reasons for removal of the catheter. As an increasing number of patients depend on a catheter as a vascular access for an extended period, maintenance of HD catheter patency is extremely important. One approach in case of catheter occlusion is thrombolysis. We describe our experience with HD catheter thrombolysis in rare patients with extreme access problems. Patients and methods In four patients (aged 77, 69, 64 and 28 years, all female) hemodialyzed via permanent HD catheters, occlusion occurred and thrombolysis was attempted. Primary patency periods were: 112 months for one surgically implanted subclavian vein silastic catheter, 74 and 46 days for two percutaneously inserted jugular vein catheters and 30 days for one surgically implanted right intra‐atrial catheter. Recombinant human tissue plasminogen activator (TPA) or urokinase was used 13 times each as a thrombolytic agent in recommended doses for catheter lysis. Heparin lock was also used three times. Results In the young patient with the intra‐atrial catheter, r‐TPA was used 13 times with modest success even in the short‐term: restoration of flow for average 11 (range, 1–23) days. Urokinase was used 13 times in the other three patients: average secondary patency time was 79 (3–109) days. Heparin was effective in restoring patency for 29 (22–34) days. No complications of thrombolytic therapy were noted. Discussion Thrombolysis of occluded HD catheter is sometimes the only way to extend its functioning time. Especially in difficult‐to‐manage cases with exhausted vascular access sites, even for catheter insertion, this might be of vital importance. In our experience, in rare patients thrombolysis is needed frequently. It can be repeated safely. Unfortunately, the effects of each treatment seem to be only short‐lived. Beside its allergogenic potential and limited effectiveness, this therapy is also very expensive.