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Nancy DuBois
TPA lock in lieu of a heparin lock??

Does anyone have experience with the use of TPA as a lock solution in a venous catheter?  We are looking forward to caring for a young bone marrow transplant recipent at home with a pheresis catheter who is still getting photopheresis 3 times a week.  Normally, these catheters are locked with high dose heparin solution, however, this patient has a severe allergy to heparin.   

If any one uses TPA to lock their catheters can you please cite a reference for this practice?  Thanks in advance for sharing your expertise and experience. 

Barbara Tinsley
I work the bone marrow
I work the bone marrow transplant unit at Denver Presbyterian hospital.  We have patients that have regular photopheresis.  We do not use high dose heparin in our catheters.  We use 3cc of 1:100 unit heparin and have not found any greater clotting issues than we have with our other catheters. 

Barbara Tinsley

nancymoureau
I was involved with two

I was involved with two studies that looked at clotting rates and use of tPA. We wanted to do further studies for prophyllatic use of tPA. What we did do was overnight dwell. No complications, fair results.

Nancy Moureau

[email protected]

Moureau N. Using Alteplase to clear occlusions. Nursing. 2002 Jan;32(1):73.

Moureau N, Mlodzik L, Poole S. Clinical Investigation-Use of Alteplase for Treatment of Occluded Central Venous Catheters in Home Care. Journal of the Association for Vascular Access, Volume 10, Number 3, Fall 2005, pp. 123-129(7)

Nancy L. Moureau, BSN, CRNI, CPUI, VA-BC

PICC Excellence, Inc

 

Sarah Jones
Sarah Jones's picture
We have had two patients

We have had two patients that had implanted ports that we locked off with tPA.  One is a weekly chemo patient, the other was a hemachromatosis patient who got monthly phlebotomies.  You can email me privately if you would like at [email protected]

Sarah Jones
Manager APN/Infusion Services/ ET
Oncology CNS

Nadine Nakazawa
There were several studies
There were several studies done with hemodialysis catheters.  One was done by Schenk.  Pts with dialysis catheters were randomized to locking with 2mg/2 ml of TPA per lumen for 2 months, and then switched to heparin 1,000 units/ml, catheter fill volume for 2 months.  The other half of the group started with heparin locks and switched to TPA locks after 2 months.  The numbers fell over the 4 month time period so that there were only about 9 to 11 evaluable patients (I think, this is off the top of my head).   There were no complications (bleeding or infection are the ones we are most concerned about), and better flow rates and fewer thrombotic occlusions with TPA compared with the heparin arm.   Although this was a very small study, each patient was their own control.   

Call Genentech (South San Francisco, CA) and ask for their Drug Info office.   They can mail or email you the articles on locking catheters with tPA.  There is another hemodialysis catheter study.

Anecdotally, we have done this:  locking with tPA in a patient with a dialysis catheter which was used post kidney transplant for 6 weeks of DHPG daily as an outpatient.  Couldn't keep his catheter patent with heparin; worked beautifully with TPA.  No infections, no complications for 6-8 weeks til catheter removal.

In vitro work at Genentech has shown that tPA is active at 37 deg for 1 week at 90% activity; up to 2 weeks with 50% activity.  Half-life is about 5 minutes---when it enters the bloodstream, the liver breaks it down quickly, but within the catheter lumen, it remains active for some time.

Nadine Nakazawa

Nadine Nakazawa, RN, BS, OCN, CRNI, VA-BC

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