I'm an educator at a providence hospital in Portland, Oregon and am looking for best practices/procedure for instilling alteplase in PD catheters for obstructions. From our own personal literature review, we've notice most of the literature is for the early 2000s. Does anyone have more current resources we can utilize to understand best practice for this intervention as we review our current process? Thanks! Allison Young MSN, RN, CMSRN
I'm an educator at a providence hospital in Portland, Oregon and am looking for best practices/procedure for instilling alteplase in PD catheters for obstructions. From our own personal literature review, we've notice most of the literature is for the early 2000s. Does anyone have more current resources we can utilize to understand best practice for this intervention as we review our current process? Thanks! Allison Young MSN, RN, CMSRN
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allison young, Nurse from Portland, Oregon asked
I'm an educator at a providence hospital in Portland, Oregon and am looking for best practices/procedure for instilling alteplase in PD catheters for obstructions. From our own personal literature review, we've notice most of the literature is for the early 2000s. Does anyone have more current resources we can utilize to understand best practice for this intervention as we review our current process? Thanks! Allison Young MSN, RN, CMSRN

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⋅ Nurses Canada and members of the ISPD Nursing Committee ⋅ December 11, 2022

We thank you for your question. Some PD centres have reported administration of tissue plasminogen activator (tPA) (alteplase, Cathflo® Activase®) useful in dissolving fibrin in malfunctioning/obstructed PD catheters. While there is no standard protocol for use of tPA in a blocked PD catheter that we are aware of, the Canadian British Columbia Provincial Renal Agency has one protocol published on their website (1). Use of tissue plasminogen activator (tPA) is also discussed under the sub-heading Mechanical Complications in the recently published ISPD guideline for PD in Acute Kidney Injury (2, page 27).
 
1.British Columbia Provincial 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
 
2.Cullis B, Al-Hwiesh A, Kilonzo K, et al. ISPD guidelines for peritoneal dialysis in acute kidney injury: 2020 update (adults). Peritoneal Dialysis International. 2021;41(1):15-31. doi:10.1177/0896860820970834 Available at: https://journals.sagepub.com/doi/10.1177/0896860820970834
 
 
 
 
 

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