doiSerbia

Tissue plasminogen activator for dysfunctional tunneled vascular catheters for hemodialysis - single center experience

Todorov Verica (Zvezdara University Medical Center, Clinical Department for Renal Diseases, Belgrade, Serbia)
Janković Aleksandar (Zvezdara University Medical Center, Clinical Department for Renal Diseases, Belgrade, Serbia)
Đurić Petar (Zvezdara University Medical Center, Clinical Department for Renal Diseases, Belgrade, Serbia)
Bulatović Ana (Zvezdara University Medical Center, Clinical Department for Renal Diseases, Belgrade, Serbia)
Popović Jovan (Zvezdara University Medical Center, Clinical Department for Renal Diseases, Belgrade, Serbia)
Dimković Nada (Zvezdara University Medical Center, Clinical Department for Renal Diseases, Belgrade, Serbia + Faculty of Medicine, Belgrade, Serbia)

Introduction/Objective. Thrombosis of hemodialysis catheters is one of the major complications, which leads to catheter dysfunction. Although tissue plasminogen activator has been proven to be effective in reestablishing blood flow rate through dysfunctional catheters, clinical data in Serbia are missing. The objective of the study was to analyze tissue plasminogen activator efficacy in reestablishing blood flow rate and the influence on catheter survival. Methods. The study included 53 tunneled catheters from 32 patients on hemodialysis. After catheter dysfunction was established, 580,000 units of tissue plasminogen activator was applied into each catheter lumen for about two hours before hemodialysis. The criteria for success was blood flow rate on the next hemodialysis – over 200 mL/minute was considered to be complete success, 180–200 mL/minute partial success, and under 180 mL/minute was considered a failure. Results. Out of 53, 25 catheters (47%) had dysfunction with an incidence of 3.8/1,000 catheter days. Catheters placed in femoral veins, “after-first” catheters, catheters with infection, and catheters in older patients had higher risk for dysfunction. Multivariate logistic regression analysis confirmed that only older age was significantly related to catheter dysfunction. Of the total of 50 applications of tissue plasminogen activator, 35 (70%) were successful, seven procedures (14%) were partially successful and eight (16%) dysfunctional catheters failed to respond to therapy. Six-, 12- and 24-month survival was 87%, 81%, and 20%, respectively, for catheters without dysfunction, and 71%, 47.5%, and 12%, respectively, for catheters with dysfunction. Conclusion. Tissue plasminogen activator dosing is noninvasive, efficient, and safe in reestablishing blood flow rate through dysfunctional catheters, thus prolonging catheters life and sparing patients from additional vascular procedures.

Keywords: hemodialysis, tunneled vascular catheters, catheter thrombosis, tissue plasminogen activator