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Use of Altepase or Cathflo on patients with Intracranial Hemorrhage w/PICCs
We use Altepase or Cathflo on most all of our paitents, even ones with bleeding issues and have had no complications. But we now have a new stroke/neuro program at our hospital and the Stroke Team nurses are saying to some of the staff nurses that they should NOT use tpa to de-clot PICCs in patients with Intracerebral Hemorrhage.     (Which incidently, we've seen an increase lately in young adults!)  Apparently the lead nurse spoke with the medical information support at Genentech and informed her that all patients with emoblic source, hx: of bleeding event were excluded from the initial COOL trials so they have no data on this population. 

I know that "bleeding" is a potential complication listed for Altepase, but I've explained to the nurses that it is such a small dose with a short 30 min half-life and technically should only sit within the catheter, that is if we can even get the entire dose in.

Any experiences or evidence on this matter would be greatly appreciated!

Raquel M. Hoag, CRNI

Dayna Holt RN CRNI
What is the rationale or
What is the rationale or evidence in the literature that a 2mg dose of TPA is detrimental to Neurosurg. patients?
Gwen Irwin
I don't understand the

I don't understand the rationale behind not using tPA on neurosurgical patients.  We have had a neuro surgeon have the PICC removed and another replaced instead of declotting one of the lumens.

If you're treating an occlusion, you are treating the catheter with tPA and aspirating for blood return that includes the tPA.  The discard of the blood includes any of the tPA, so the patient doesn't even receive a dose.  Also, the dose is so small that is given via PICC that it makes even less sense to me.

Gwen Irwin

Austin, Texas

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