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Walker
Alteplase and Midlines

Does anyone have any data or research articles on alteplasing occluded midlines?  Just curious.  We have been using Bard PowerGlide RTs.  The RT indicates a reinforced tip.  We have been using these products for over 5 years.  We have been quite happy with the dwell time, ease of insertion, and simplicity of these devices.  Essentially an extended dwell IV inserted sterily under ultrasound guidance.  We actually use them quite a bit in antepartum when our OB/GYN MDs want long term 18 gauge access.  The blood draw ability of these devices is short lived, and I'm curious to using alteplase or other catheter clearing medicaton for these.  I'm also wondering if these is an injection cap issue.  We use a microclave clear connector  on our extension tubing.  Without the proper flushing locking technique a small amount of blood aspiration is possible occluding the end of the catheter detering consistent blood return and lab draws. This device is a neutral displacement connector has any one had better luck with a positive connector on midlnie devices and blood draws. Or are institutions actually using alteplase for these IVADs.  Our alteplase rep is adamant that alteplase will clear our midlines devices, but I have found them to be rather finnicky with blood drawabilty.  Please advise. 

Andrew Walker RN, BSN, VA-BC, CRNI

[email protected]

lynncrni
There are no studies at

There are no studies at present on using tPA for clearing a thrombotic occlusion in any short PIVC, long PIVC, or midline catheter. There has been podium presentations on using tPA for midlines, and a nurse in Indiana is doing research on this but not published yet. The reason you are having problem drawing blood is because of the very large 18 g. Lots of evidence now showing that peirpheral veins, especially in women, are not large enough to allow for a catheter to vein ratio of a third - only a third of the vein lumen consumed by the catheter. Smaller is always going to be better. Vein wall edema and early products of vein thrombosis are more than likely causing your difficulty with blood sampling in these large gauge catheters in veins not large enough to accommodate them. 

Lynn Hadaway, M.Ed., RN, NPD-BC, CRNI

Lynn Hadaway Associates, Inc.

PO Box 10

Milner, GA 30257

Website http://www.hadawayassociates.com

Office Phone 770-358-7861

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