Alteplase

I.V. Rounds

LOSS OF PATENCY is the most common complication of central vascular access devices (VADs), and catheter occlusion from thrombosis is one of the most common causes of patency loss.

Thrombolytic drugs have been used to clear occluded catheters safely in all health care settings. Besides being faster and less traumatic for the patient, using them to clear a thrombotic occlusion is less expensive than replacing the VAD. Replacing a peripherally inserted central catheter, for example, costs up to $175, compared with $80 for thrombolytic therapy.

In September, the Food and Drug Administration approved alteplase (Cathflo Activase) for clearing thrombotic occlusions in central VADs. The only drug approved for this use, it's now available in 2-mg vials.

Here are the basic steps for using alteplase to clear an occluded central catheter:

* Prepare the alteplase as directed on the package, for a concentration of 1 mg/ml. Withdraw 2 ml into a 10-ml syringe.

* Using aseptic technique, clean the catheter hub with an approved antimicrobial solution. Attach a 10-ml syringe to the hub. Attempt to aspirate for a blood return.

* If no blood returns, connect the syringe with the alteplase and instill the alteplase into the catheter. Disconnect the syringe and clamp the catheter tubing. Wait 30 minutes. (For a description of another method of instillation, see A New Protocol for Instilling Alteplase.)

* After 30 minutes, again try to aspirate. If you can aspirate blood, withdraw 4 to 5 ml of blood. Then gently irrigate the catheter with the amount of 0.9% sodium chloride solution recommended by the catheter manufacturer. Use a push-pause (pulsing) method to flush.

* If you can't aspirate blood after waiting 30 minutes, wait until 2 hours have elapsed, then try again. If you still can't obtain a blood return, instill a second dose of alteplase and repeat the process.

The safety and efficacy of alteplase for catheter clearance hasn't been tested in children under 22 pounds (10 kg) or for doses more than 4 mg (two 2-- mg doses).

BY NANCY MOUREAU, RN,CRNI, BSN

President - PICC Excellence, Inc. - Orange Park, Fla.

Copyright Springhouse Corporation Jan 2002
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