Q: I am a CAPD clinical co-ordinator in India. I am providing clinical service to CAPD patients. I got a problem of fibrin in certain patient. It’s coming out in large quantity. I gave Heparin 5000 IU in 1st bag then continuous each Exchange is 1000 IU. But till now the problem has not cleared. Drain is also clear. The patient does not have any other problem, and is in good health. What can I do for this?

A:The presence of fibrin in dialysate fluid may indicate poor dialysate outflow, resulting in drainage volume being less than the inflow volume. Though adding heparin (500U/L) is a usual intervention to deal with the presence of fibrin strands in the dialysate fluid, it is advisable to use heparin prophylactically, that is even in the absence of fibrin in the fluid. Alternatively, one could also instill Urokinase (5000U), a thrombolytic agent, into the catheter for one hour and then remove it followed by instillation of heparin in the dialysate for several exchanges. Lastly, success has been reported with recombinant tissue-type plasminogen activator or tPA like Alteplase when used to treat catheter obstruction by fibrin clot.