Neonatal Drug Therapy Manual


Disclaimer: Official controlled document is the CHEO and Ottawa Hospital online copy. It is the responsibility of user to ensure that any paper copy version is the same as the online version before use.

Alternate Name(s): 
Activase, CathFlo, Tissue Plasminogen Activator, TPA
Original Date: 
August 2003
Revised Date: 
May 2013
  • Treatment of blocked central venous catheter:
    • Blood related blockage
    • Consider other causes of central venous catheter occlusion (ex. mechanical failure, constriction by a suture, catheter malposition, drug precipitates or lipid deposits within the lumen of the catheter) before using alteplase
  • Intra central venous access instillation
CVAD Type Alteplase Volume

PICCs, Tunneled/Non-Tunneled (Per-Q Cath/Broviac/Arrow) Catheters

 0.5 mL (1 mg/mL)
  • Instill in each lumen over 1 - 2 minutes, leave in lumen for 1 - 2 hours, then aspirate out of catheter, do not infuse into patient. Flush catheter with 0.9% NaCl
  • Do not force an obstruction since it could cause emboli to enter venous system 


  • NOTE: Do not administer to patient awaiting cardiovascular surgery (up to 1 week prior to surgery) and up to two months post operatively without contacting the cardiovascular service.
Side Effects: 
  • For local instillation, systemic side effects are not likely to occur
Parameters to Monitor: 
Reconstitution and Stability: 
  • Alteplase 2 mg vial
    • Add 2.2 mL sterile water 
    • Final concentration: 1 mg/mL
    • Allow vial to stand undisturbed until large bubbles disappear.  Mix by gently swirling.  DO NOT SHAKE.  A colourless to pale yellow transparent solution results.
    • DO NOT USE if solution is discoloured or particulates or precipitates appear.
  • Use 5 micron filter needle to remove solution from vial
  • Reconstituted solution stable 8 hours at room temperature or refrigerated
  • Store unopened vials of alteplase (CathFlo) in the refrigerator


  • Use of > 2 doses of alteplase for blocked central lines has not been studied

-Taketomo CK, Hodding JH, Kraus DM. Pediatric Dosage Handbook 19th Edition. Hudson: Lexi-Comp Inc.; 2012

-Protocol for the management of blocked central venous access devices. In: The Children's Hospital of Eastern Ontario Infusion Therapy Manual. (last revision Feb 2003)

- Trissel LA. Handbook on Injectable Drugs. 16th Edition.  Bethesda: American Society of Health-System Pharmacists2010

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