- 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.
- For local instillation, systemic side effects are not likely to occur
- 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