Streptokinase Therapy for Occluded Tenckhoff Catheters in Children on CAPO

Streptokinase was infused through the partially thrombosed Tenckhoff catheters of four children on continuous ambulatory peritoneal dialysis (CAPD). Radiographic contrast studies performed before and after the infusions demonstrated dramatic dissolution of the fibrin thrombi associated with restoration of normal catheter function. The catheters subsequently functioned for an average of 12.5 months. No allergic or hemorrhagic complications were noted in association with the infusions. Coagulation studies revealed no evidence for systemic streptokinase absorption. We suggest that streptokinase, when given in the manner described, is a safe and effective treatment of thrombosed Tenckhoff catheters in children.

Use of Alteplase for Clearing Peritoneal Dialysis Catheter Occlusion

Background

Peritoneal dialysis (PD) catheter complications account for 20% of all transfers from PD to hemodialysis. One complication is outflow obstruction caused by fibrin deposits within the lumen of the catheter. Alteplase is frequently used to clear fibrin deposits in PD catheters that are refractory to other therapies. However, the literature basis for this practice is unclear.

Method

A review of the literature was conducted to determine the evidence existing for alteplase use in PD catheter occlusion due to fibrin. A literature search of MEDLINE (1967-present) was conducted using the search terms "alteplase", "peritoneal dialysis catheter", "occlusion", "fibrin", and "tissue plasminogen activator". Referenced citations were also searched for pertinent material. All data concerning the use of alteplase for peritoneal dialysis catheter occlusion were included in this review. The search resulted in 1 open-label pilot study, 3 case series, and 2 case reports of alteplase use in declotting occluded PD catheters.

Results

Based on the data, alteplase therapy cleared the occlusion of PD catheters in the majority of cases. In those that were unsuccessful, other surgically correctable and mechanical causes were identified in most cases.

Conclusion

Alteplase appears to be an intriguing alternative to the surgical removal of the PD catheter in patients with catheter occlusion due to fibrin. Although not inexpensive, it appears safe and may decrease the need for surgical correction of occluded catheters.