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tpa amt in 2Fr PICCs in neonates
Our NICU policy states to use tpa for catheter clearance in the amount of the catheter fill volume, yet some literature says "fill volume plus 10%".  Does anyone know of literature supporting one or the other?
Angela Lee
These catheters are so small
These catheters are so small and are cut to fit the patient so it's difficult to know what the fill volume is.  More often than not you're talking about less than 0.10 ml.  Our tpa is prepared and sent to us by pharmacy in 0.50 ml volumes.  It is easy to control your instillation volume when you're working with that little.  It is sometimes necessary to do a second instillation as well.  I am aware of but don't obsess about the instillation volume--if your obstruction is complete you can't get very much in anyway and if it clears it clears with less than .20 ml usually.  The longer the catheter has been occluded the longer it takes to clear and I find the key is sometimes waiting rather than the volume used, to allow the tpa to work down the length of these small catheters.
Denise Harper
Cathflo is the only FDA

Cathflo is the only FDA approved product for catheter clearance.

The pediatric trials were conducted on children 2 weeks to 16 years of age.

Patients weighing less than 30 kg the suggested dose is 110% of the estimated internal volume, not to exceed 2 ml (2mg). For those over 30 kg the dose is 2 ml (2 mg).

Your Genentech rep can provide you with additional education as needed.

Denise Harper, RN, CRNI

Vascular Access Program

PCMH

NC

Denise Harper, RN, CRNI

ANM Vascular Access Program

PCMH

NC

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