Can we make the vascular access for hemodialysis through the neck lines (central lines) more safer and long lasting?

Vascular access for hemodialysis is known to frequently thrombose and force us to go for revision or create a new vascular access. Central lines are flushed with heparin to prevent the thrombosis but even then some catheters get blocked due to thrombosis and others develop the infection. Such catheters are treated with rtPA (1mg) to lyse the clots in the catheter. Loss of access can be expensive and one has to go for another one. In a recent study published in NEJM it was observed routine use of rtPA (1mg) once in a week in addition to twice a week Heparin irrigation of the catheter can prevent the thrombosis and bacteremia. Brenda RH ( preCLOT study group) did this study and it is very interesting to findout that elective use of rtPA can increase the patency and prevent the bacteremia in those patients undergoing dialysis through the central neck lines. Soon the 1mg rtPA prefilled syringes may be available in many countries to irrigate the the central lines for better patency. We can congratulate Brenda R H et al for conducting this study which can help the hemodialysis patients.