Back
We describe a peritoneal dialysis (PD) patient with an intraluminal catheter blood clot that failed attempts with intraluminal thrombolytic administration and brushing procedure. Eventually, the catheter was salvaged, and an accelerated catheter-directed thrombolytic agent was able to completely restore the catheter's function.
An 80-year-old man presented at the hospital with bloody PD effluent, accompanied by negative ultrafiltration (UF). The patient had been diagnosed with kidney failure and had undergone PD for the past three years. Additionally, he had persistent atrial fibrillation and was receiving warfarin.
During admission, a rapid fill and drain test revealed outflow failure. Plain KUB film revealed a good catheter tip position. The push-pull syringe test revealed a blood clot but was unsuccessful in dislodging the clot. Despite three attempts at using rTPA, a fibrinolytic agent, the outflow obstruction persisted, with blood clots and fibrin in the effluent drainage. Intraluminal brushing was performed with partial salvage, and later, recurrent obstruction occurred. Hence, a laparoscopic revision was performed but had to be terminated because of intraoperative hypotension. Eventually, an Endoscopic Retrograde Cholangiopancreatography (ERCP) catheter with a Swing Tip cannula and directed infusion of thrombolytic agent was used to salvage the catheter, resulting in success. Subsequently, computerized tomography (CT) peritoneography confirmed the successful salvage of the catheter.
Here, we have introduced an innovative approach utilizing an ERCP catheter with a Swing Tip cannula and a thrombolytic agent as a final resource for catheter obstruction if the patient's condition is unsuitable for laparoscopic revision and hemodialysis.