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Catheter Dysfunction Thrombolytic Lock — ESENeph MCQ

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EasyHaemodialysisCatheter Dysfunction Thrombolytic LockESENeph

A 60-year-old man on haemodialysis has a tunnelled catheter in the right internal jugular vein. He develops catheter dysfunction with poor blood flow. The catheter has been in situ for 3 months. Before removing and replacing the catheter, what is a first-line salvage intervention?

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Correct answer: B — Intraluminal thrombolytic lock (Alteplase/Urokinase) to dissolve fibrin sheath/thrombus within the catheter

Catheter dysfunction from fibrin sheath formation or intraluminal thrombus is common. First-line salvage involves instilling a thrombolytic agent (Alteplase 2 mg in each lumen, dwell for 30-120 minutes). This dissolves fibrin and restores catheter patency in 50-80% of cases. Line reversal (connecting arterial to venous and vice versa) is a temporary measure that reduces effective dialysis dose (increased recirculation). If thrombolytic locks fail, catheter exchange over a guidewire or complete replacement is needed. UKKA recommends thrombolytic locks before catheter exchange.

Reference: UKKA 2019 – Vascular Access; KDOQI 2019 – VA Update