Neonatal Drug Therapy Manual

Alteplase

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Updated June 19, 2024 - 3:43pm

Alternate Name(s): 
Activase, CathFlo, Tissue Plasminogen Activator, TPA
Classification: 
Thrombolytic
Original Date: 
August 2003
Revised Date: 
March 2024
Indications: 
  • 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
Administration: 
  • Intra central venous access instillation
Dosage: 
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
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.
  • Reconstituted solution stable 8 hours at room temperature or refrigerated
  • Store unopened vials of alteplase (CathFlo) in the refrigerator
Compatibility: 

N/A

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

-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)

- Communication with Medical Information Roche Canada, March 2024

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

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