Questions About PD
We thank you for your question: “How to manage a blocked PD catheter with heparin?”
Management of a “blocked” PD catheter (no inflow, no outflow, or both) depends on the cause of the PD catheter malfunction. Usually, it is good practice to first double-check that indeed all the clamps on the PD set are open, there are no kinks in the tubing, and try to reposition the patient. If not successful, then our local practice is to irrigate the PD catheter using a 10 mL syringe with normal saline or 1.5% PD solution using a push/pull technique to flush out fibrin or clots from the PD catheter (aseptic technique). If fibrin is observed, then heparin 500 units per liter of PD fluid should be added IP to all the subsequent PD exchanges for the next 24 hours, then reassessed. Heparin will prevent further fibrin formation, but will not dissolve the fibrin.
If irrigation of the PD catheter is not successful, then the patient should be assessed for other causes of malfunction e.g. constipation, PD catheter malposition or kinking, or omental wrapping. An Xray (flat plate of the abdomen) is helpful to assess the patient for constipation or PD catheter malposition/kinking.
Of note: heparin is not usually thought to be effective at dissolving fibrin. However, some PD centres have reported administration of tissue plasminogen activator (TPA) (Cathflo, Activase) useful in dissolving fibrin in malfunctioning PD catheters. There is no standard protocol for use of TPA in a blocked PD catheter, but the Canadian British Columbia Renal Agency has one protocol published on their website (1)
- British Columbia Renal Agency (2018). Alteplase (Cathflo®) Administration for Occluded Peritoneal Dialysis Catheter. Available at http://www.bcrenalagency.ca/resource-gallery/Documents/Alteplase%20%28Cathflo%C2%AE%29%20Administration%20for%20Occluded%20Peritoneal%20Dialysis%20Catheter.pdf