For use with all central venous catheters.

Thrombotic occlusion is a common complication of central venous catheters. This condition can lead to the interruption of intravenous therapies essential for patient care. Thrombolytic agents are used to restore catheter patency in an attempt to salvage the catheter and avoid the risks and expense associated with catheter replacement.

Urokinase has been used for many years for catheter clearance. Due to concern by the FDA on potential contamination of urokinase, it is no longer commercially available. After a review of the literature and standards of practice in academic medical centers around the country, UAMS is switching from urokinase to alteplase (recombinant tissue plasminogen activator (t-PA) for catheter clearance.

Following standard procedures of sterile technique in the Pharmacy Sterile Preparation Room, the UAMS pharmacy shall reconstitute alteplase to 1mg/ml and prefill 1 mg in a 3 ml syringe. The syringes shall be frozen and given a 6 month expiration date. Until such time as a reliable source is available commercially, this product will be used for clearing clotted catheter lines.

1. Determine that the venous access device is occluded. Rule out mechanical obstruction of the line.
2. Obtain physician written order for alteplase 1 mg / ml.
3. Determine the volume of normal saline (NS) that will need to be instilled following the alteplase according to manufacturer’s information on catheter volume. Dialysis catheters should receive the exact volume of the catheter.
4. Instill 1mg alteplase then follow with Normal Saline (as in item #3, above) into the catheter and allow it to dwell for 1 hour.
5. If patency is restored, withdraw 5 ml, discard and flush catheter with 20 ml Normal Saline.
6. If patency is not restored, re-evaluate the patient for potential mechanical obstruction.
7. A second dose may be given if patency is not restored with the first dose.
8. Monitor for potential adverse effects, including minor bleeding and bruising.