Use of tissue plasminogen activator in peritoneal dialysis catheters: a literature review and one center's experience.

There have been anecdotal reports of the use of tPA for obstructed peritoneal dialysis catheters in both adults and children. This manuscript reviews the literature and summarizes common elements of the procedures used for tPA administration in peritoneal dialysis catheters. The Gambro New Haven experience with administration of tPA (8 mgs in 10 ml of sterile water injected into the catheter and allowed to dwell for 1 hour) in 29 cases of catheter obstruction in 18 patients is presented. Patency was restored in 24 instances with no adverse effects. In the 5 cases that did not respond, the primary cause of poor drain was catheter malposition in 2, constipation in 2, and adhesions in 1. tPA was also administered to 5 patients with relapsing peritonitis; 3 patients, all with Staphylococcus epidermidis, recovered and did not experience further recurrence.