The Use of Alteplase for Treatment of Occluded Central Venous Catheters in Home Care
Purpose. The purpose of this trial was to confirm safety and efficacy with thrombolytic use on complete and partially occluded central catheters using alteplase for the home care population. This trial attempts to provide additional evidence for the safe and effective use of a thrombolytic agent for catheter clearance, specifically with home care patients. Method. Patients were eligible for inclusion if (1) blood could not be withdrawn for partial occlusion or (2) blood could not be withdrawn and inability to flush presented with complete occlusion. Through an established Protocol, using the negative-pressure technique, nurses administered alteplase, 1mg/1 cc concentration, to home care patients who met inclusion criteria. Instillations were repeated at 20-minute intervals for up to three repetitions, if needed, with the third instillation remaining overnight. Results. Instillation of alteplase was successful in clearing catheter thrombotic occlusions in 66. 7% of patients studied in this outpatient population without thrombolytic events or drug related adverse effects. Conclusions. The authors confirm that catheter occlusions can be safely resolved in the alternate care/home care setting using established negative-pressure protocols. Although overnight dwell was used successfully and unsuccessfully in this trial without adverse effects, the small sample size does not Provide adequate definitive conclusions.Abstract
Contributor Notes
Nancy Moureau, BSN, CRNI, received her Bachelor of Science in nursing from East Carolina University. She has extensive experience in pediatric, intensive care, home health, and home infusion nursing. Moureau is president of PICC Excellence, Inc., an educational company; she has more than 15 years experience in insertion and instruction of PICCs and is considered an expert in this field. Lisa Mlodzik, BS, PharmD, received a Bachelor of Science degree in life sciences from the University of Wisconsin, Parkside; a Bachelor of Science degree in pharmacy from the University of Minnesota, College of Pharmacy; a Doctor of Pharmacy degree from Mid-western University, Chicago College of Pharmacy; and a certification in the practice of geriatric pharmacy. Mlodzik is founder and president of Rxcellence, a medication management/pharmacy consulting company. She has experience in clinical operations, research, and project management and has practiced pharmacy for over 18 years. Mlodzik was employed with Option Care during the initiation of the trial and continued as pharmacy trial coordinator/consultant throughout. Susan Markel Pool, BSN, CRNI, CNSN, received her Bachelor of Science in nursing from Arizona State University and Master of Nutrition from California State University, Chico. With a background in emergency room nursing and critical care, she began her home infusion experience in 1984. At the time of this study Pool was senior director of professional services with Option Care. With more than 20 years experience with PICCs, Pool was one of the PICC pioneers in the United States.