Dr Anita Miranda1, Ms Elzbieta Mendrun1, Dr Kannaiyan Rabindranath1, Dr Eddie Tan1
1Waikato District Health Board, , Aotearoa / New Zealand
Biography:
Anita is a current second year Advanced Trainee at Waikato Hospital and is currently dual training in Nephrology and General Medicine. Her main interests lie in the fields of Interventional Nephrology and Supportive Care. In her spare time, she enjoys a good book and a well brewed cup of tea.
Abstract:
Background:
Tunnelled central venous catheters (CVCs) are commonly used within the haemodialysis (HD) population as an alternative to arteriovenous fistulae or arteriovenous graft. A frequently encountered complication of their use is catheter dysfunction due to thrombus and fibrin sheath formation. Our objective is to determine the rate of use and effectiveness of alteplase in HD catheters with poor flow due to presumed thrombus/fibrin sheath.
Method:
All tunnelled HD CVC lines inserted for Waikato District Health Board patients were reviewed.
Results:
207 HD CVCs were inserted between 01.01.2021 and 30.09.2023. 69(33%) received alteplase. Median time from insertion to first dose was 130 days. Median time from first dose of alteplase to catheter removal was 208 days. There was a statistically significant correlation between the overall median duration of catheter use and the need for alteplase (38.5 days vs 209 days, p<0.001) . 12 catheters required railroad for malfunction/misplacement, 9 of which occurred in those that received alteplase. There was no significant correlation between age, gender, ethnicity, diabetes, hypertension, heart disease or use of antiplatelet agents or anticoagulation, number of previous catheters and the need for alteplase administration.
Conclusion:
Alteplase remains a useful method for maintaining function and patency of tunnelled haemodialysis, especially in environments where definitive HD access is difficult to obtain.