In my previous expereince, my team would place 2mg of alteplase in 25cc of solution and infuse it over 2-4 hours, in each lumen. This created an opportunity for the drug to dissolve more of the sheath covering the end of the catheter. The rule we used was if a catheter was tpa'd three times, then we repalced the catheter or did the infusion. If the catheter was replaced, we used a different arm. The results were positive for doing this infusion.
Doubt if you find any literature on this but if you do, please pass it on.
Cheryl Kelley RN BSN, VA-BC
Lynn Hadaway, M.Ed., NPD-BC, CRNI
Lynn Hadaway Associates, Inc.
PO Box 10
Milner, GA 30257
Office Phone 770-358-7861
When developing our Restoring CVAD Patency policy, I could only find 1 article referring to Alteplase infustions. Unfortunately, I can't locate it at home, will check if I have it at the office. This article referred to Alteplase infusions in the hemodialysis population- you may want to search these 2 terms. I'll also try to get an electronic copy our our facility's Alteplase infusion policy to post.Daphne BroadhurstOttawa Canada
Daphne BroadhurstDesjardins PharmacyOttawa, Canada
For those of you administering a 2 hour alteplase infusion. Does your policy specify how often it can be done for a patient?