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Michael Johnson
Home Health RNs doing tPA (Cathflow) in the field

Hello all--

I am trying to gather information and/or even a policy on HH RN's doing Cathflo at patients' homes.

I am case manager for a 36-chair outpatient infusion center.  We are swamped most of the time.  HH calls us for tPA on a regular basis--well--once a month really.  We ofetne don;t have rrom to see the HH patients.

These patients really are homebound and it is difficult for them to get in--even if we have a opening.  Many years I have tried to get HH to do CathFLo.  I want to give them some printed help to maybe have them do this finally.

Any info is helpful--Thanks!

Daphne Broadhurst
Our PICC program is also

Our PICC program is also faced with similar challenges- spending ++ time troubleshooting outpatient complications, thus preventing timely PICC placements & unfortunately often delays in outpatient occlusion management. I've started looking into whether declotting into the community may improve both patient & process outcomes. Below are some references. I believe one of Lisa Gorski's articles had a sample physician's order for declotting. I emailed Nancy Moureau (google "PICC Excellence") & she very kindly sent me the Cathflo protocol used for her study. Nancy's PICCOLO I study (2002) not only shows the incidence of catheter occlusion in the community but also the quantifies the impact of these occlusions (i.e., # ER visits, unscheduled IV starts...) which clearly demonstrates the need for prompt identification & management of catheter occlusions. The follow-up PICCOLO II study (2005) demonstrates the efficacy & safety of declotting in the community.

Presently in Canada, all declotting is performed in the hospital setting. One of the chief obstacles to bringing this into the home health care setting is reimbursement, as Cathflo is not covered by our provincial health plan. We will be dialoguing with the Ministry of Health to see if there is a solution to this. Another concern is maintaining competency of the nurses- a proposed strategy is to have this procedure performed in the agencies' clinics, in a controlled setting with a select group trained to declot or to have this procedure performed in home by the agencies' nurse specialists.

Michael, if you are successful in this endeavour or have any contact information for agencies who are performing declotting in the home health care setting, I would very much appreciate if you could contact me at shseca[at]yahoo[dot]ca

Good luck with this initiative. Daphne

Moureau N. Central Venous Catheters in Home Infusion Care: Outcomes Analysis in 50,470 Patients. J Vasc Interv Radiol 2002; 13:1009–1016

Moureau N. The use of Alteplase for treatment of occluded central venous catheters in home care. JAVA 2005; 10(3) 123-129

Gorski LA. Central venous access device outcomes in a homecare
agency: a 7-year study. J Infusion Nurs. 2004;27(2):104-111

Gorski LA. Central venous access device occlusions, Part 1: thrombotic causes and treatment. Home Healthcare Nurse. 2003;21(2):115-121.(Summary: "Thrombotic CVAD occlusion can be treated in the home setting using the thrombolytic drug alteplase as described in this article.")

Daphne Broadhurst
Desjardins Pharmacy
Ottawa, Canada

Michael Johnson
Wow.  Thanks for all the

Wow.  Thanks for all the great info!

Reimbursment is easy for we are our insurance, our clinics, our hospital, our doctors, and our pharmacy.  Kaiser is a one-stop shop kind of thing. 

I will look at those articles and forward to the director of Home Health.

Thank you so much



Terry Hall
Infusion companies in
Infusion companies in Northern California use Cath Flo in the home and have for at least the past five years. It's usually used whenever the catheter is "sluggish",  or has a withdrawal occlusion. We try to prevent complete catheter occlusion. But, if necessary, we will declot the line at home. I have several long term patients who are homebound and on long term IV therapy. We actually keep activase (Cath Flo) in the home and have a prn order to use it to restore catheter patency. The nurses who administer Cath Flo must be inserviced and competency tested before they're permitted to administer it ie Cath Flo. Genetech has excellent inservicing and competency testing info. that they'll be happy to shaare.
Michael Johnson
Thank you Terry!   I shall

Thank you Terry!


I shall let HH know that others do do it.




Terry, Can you share how you


Can you share how you were able to get reimbursed for this drug in the home setting?  What code youused for billing?  Did the nurse stay in the home while the drug was instilled?   This is very valuable information to share as here in the east it is generally understood that a home health agency cannot get reimbursement for declotting in the home.  Did you fiind that you were able to use the drug in the home setting for patient's who had insurance or was this true for medicaid / medicare patients too?  I know medicare reimbursment if very poor (or absent) for IV therapy in home setings.

Many thanks.


Cheryl Kelley RN BSN, VA-BC

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