Dr. Umanath is now with the Division of Nephrology and Hypertension, Henry Ford Hospital, Detroit, MI.
In-Center Thrombolysis for Clotted AV Access: A Cohort Review
Version of Record online: 12 JUL 2012
© 2012 Wiley Periodicals, Inc.
Seminars in Dialysis
Volume 26, Issue 1, pages 124–129, January/February 2013
How to Cite
Umanath, K., Morrison, R. S., Christopher Wilbeck, J., Schulman, G., Bream, P. and Dwyer, J. P. (2013), In-Center Thrombolysis for Clotted AV Access: A Cohort Review. Seminars in Dialysis, 26: 124–129. doi: 10.1111/j.1525-139X.2012.01105.x
Dr. Wilbeck is now with Nashville Nephrology Associates, Nashville, TN.
- Issue online: 24 JAN 2013
- Version of Record online: 12 JUL 2012
Thrombosis is the leading cause of arteriovenous (AV) access failure for hemodialysis patients requiring frequent interventions. We describe a novel approach to the lyse-and-wait technique in thrombosed AV access using nurse-administered thrombolytics in a hospital-based hemodialysis unit. All patients at a single-center, large, urban, tertiary care hospital, who underwent in-center thrombolysis via alteplase instilled directly into a thrombosed AV access by inpatient hemodialysis unit staff between January 1, 2003 and December 31, 2007, were eligible. Included subjects were at least 18 years old and did not have known or suspected infection or trauma to the AV access site. Primary outcome measure was successful thrombolysis defined as hemodialysis performed immediately or after the interventional radiology (IR) procedure. Adverse events related to the procedure were collected. A total of 321 procedures, performed on 145 subjects (77 (53%) male, 68 (47%) female) remained for analysis. Successful instillation occurred in 317 of 321 procedures (98.8%). Successful thrombolysis occurred in 237 of 321 procedures (73.8%). Adverse events (8 major and 10 minor) occurred in 18 procedures, yielding a complication rate of 5.6%. In-center thrombolysis with alteplase administration by hemodialysis unit nursing staff under physician supervision is safe and effective with an adverse outcome rate similar to the literature. Thus, this modified lyse-and-wait protocol can be adopted with appropriate IR and surgical backup in place.