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cathflo multilumen

Does anyone attempt clearing partially occluded PICC lumens with Cathflo TPA 2mg/2ml on more than 1 lumen at a time. We have been doing 1 vial to each lumen (up to 3 lumens) instillations simultaneously. The Gentech folks didn't have any data to support this, but it dosn't say anywhere to only instill 2mg per ?whatever time frame?. The only data I saw said that with a direct 2mg IV bolus, serum concentrations would return to exogenous levels within 30 min.

Angela Williams
 I am interested in this as

 I am interested in this as well, my understanding is not exceed 4mg..2 doses...but with usage of triple lumen PICC's, we are called frequently for lack of blood return on all 3 or 1 occluded and other 2 sluggish, etc...have potential to use 2 doses per line (6 total=12 mg)...and then how often can you do that? When do you say enough is enough? (I know, education and accountability is a factor here)

Angela Williams RN BSN CRNI

Clark Memorial Hospital

Jeffersonville IN

Gwen Irwin
Cathflo multilumen

I would ask someone from Genentech that question.  

I think that all lumens can be treated, since we have treated all lumens.  Sometimes, treating all lumens isn't possible, so we interrupt/change the infusion to another lumen while we treat 1 at a time.  BUT I would prefer that info about treating all lumens to come from the manufacturer.  I will try to check with our rep.  Seems that she has provided us info in the past.

Gwen Irwin  

My Genentech rep. states 4 mg

My Genentech rep. states 4 mg in 24 hours.  For multiple lumens we have divided up the doses so as not to exceed the 4 mg.

katie CRNI
the package insert does not

the package insert does not specify the total you can use or under what circumstances. I believe Genentech leaves that up to each individual facility policy. PI only states you can use up to 2 doses per lumen each occurance of partial or complete occlusion. Adult (over 30 kg) dose is the full 2 mgs as they encourage "overfilling" catheter to get any fibrin buildup on the outside of the catheter such as a tail or sheath. Pediatric dose (under 30 kg) listed is 110% of the internal fill volume of the catheter up to 2 ml. At our facility we will treat all lumens with partial or complete occlusion s/s up to 2 doses and up to 2 x per lumen. If the catheter has been treated more than 2 times in 2 weeks we order a cxr to verify correct placement.

cathflo multilumen

For withdraw occlusions of open ended catheters, treating one lumen usually resolves the occlusion that is most probably occurring on the outside of the catheter.

Nancy Rose 

Ann Williams RN CRNI
I work for a home infusion

I work for a home infusion company and ever since early in Cathflo life, we have declotted both lumens even if one is still functional.  We found if we only treated the troublesome lumen, we ended up going back out a few days later to do the other lumen.  If you look at how close the exits are on a dble lumen, you will realize that there is probably some fibrin already forming over the 2nd lumen.  Genentech can't speak on this because it was not tested this way during the trials.  Therefore, their legal response is that they can't speak to that as they have no information.

Do not ever split doses between lumens.  You are only asking for a failed declot attempt.  No matter how many lumens, the dose is 2mg/ml per lumen x2 as needed for persons over 30kg.  (& 110% of internal lumen volume in persons less than 30kg)There is also no time limit on how often you can readminister the Cathflo Activase.  You can treat again in 12 hours, 1 day, etc.  I was recently at a Genentech Clinical Trainer workshop and this came up.  There was much confusion in the room, even with Genentech folks having heard different times.  The final word was that there is no limit, as long as you always stick to the 2mg/ml/lumen x2 as needed in persons over 30kg.

I hope this answers some of the questions....

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