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Declotting Central lines

Is anyone still using tPA alloquatted from pharmacy? Has anyone had to deal with a pharmacy who insists on sending 1mg doses instead of 2mg to declot central lines?

Our pharmacy has been doing this for years, and while I am trying to fight this, sent them the COOL 1 and COOL 2 studies, they now came up with a solution of diluting the 1mg dose of tPA into 2ml of sterile water. I am getting tired of talking to these pharmacists who are thinking this practice is alright because it will save money, when we all know if the clot is not completely removed, we are placing our patients at a higher risk for infection, etc. Help please!


Angela Lee
We order by dose.  Because I

We order by dose.  Because I work in peds .5mg is usually sufficent for catheter clearance especially in the smaller PICCs.  If a port or tunneled catheter needs tPA I will order an appropriate dose up to 2 mg.  Our pharmacy sends what's ordered rather than what they think we should need.  If there is an dose specific order I'm not sure how a pharmacy can justify sending a lesser dose or diluting.

Change is hard for all of us.

Change is hard for all of us. Alloquatted dosing is sub therapeutic (1mg), it is time consuming for the pharmacy and has a higher % of wasting the dose. 2MG/2ML is the dose to treat occluded CVCs this is what the FDA has approved. Call your sales rep from Genentch to come in to do the education and provide them with literature to support it. Peds is dosed as 110% of the intra luminal volume for patients less than 30KG. You will use less if used properly.

You absolutely right by not maintaining the line properly we do increase the risk of infection. Zero is the goal. Good luck!

Not sure why the last part on

Not sure why the last part on previous post is posting with this new post?

We alloquatte using 1mg/1cc

We alloquatte using 1mg/1cc but pharmacy gives us a 2cc dose for TPA clearence.

Declot issue

I assessed a solo2 power PICC and found the purple port had some resistance to flushing, but a normal blood return. The other port had no difficulties either way. I instilled 2mg Cathflo into the purple port and let it sit for almost 1 hr. I then aspirated blood and cathflo and discarded (5cc). Then put on new cap and flushed with saline. The problem is the blood flow is still OK, but the resistance with flushing I orginally encountered is the same--no change after using the Cathflo. Why would there be resistance to flushing when the blood return is normal? Any thoughts? Would it have made any difference to let the Cathflo sit longer? There would be no way to know if it was effective since the blood return wasn't the problem. I haven't encountered this before.


Tami Mendonca, RN





Oops--wrong post

Sorry, previous question about declot in the wrong post.

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