Alteplase infusion for clotted port

[Cincinatti1978]

A coworker had a pt that has facial swelling caused by a clot in her mediport. The MDs did not want the alteplase to just dwell in her line, instead they ordered an alteplase infusion. We do not do that on our floor and the pt was being upgraded to ICU. I'm confused because later in the night a doctor asked if we were using alteplase to make the line functional or to break up the clot. Would I be incorrect? If Alteplase is used, the clot can then dissolve and help reduce facial swelling, right? The clot wouldn't break off and then travel to other parts of her body, right? Alteplase would hopefully dissolve the clot first? Thank you!

[SierraBravo]

As you stated, an alteplase infusion and an alteplase dwell are two completely different therapies. I've on seen alteplase infusions on a step-down or ICU unit. Actually, I've seen it on a stroke telemetry unit. But anyway, good question. The patient is not likely having facial swelling due to the clot in her mediport. The patient likely has a clot in an upper extremity vein or a neck vein. I would be asking for an ultrasound of the upper extremities and neck.

So I would still instill the alteplase into the mediport to dissolve that clot because that won't be absorbed systemically. Unfortunately, resolving the clot in the mediport likely won't have any effect on the facial swelling. Of course, you have to look at the clinical picture of the patient. Are they septic? Sepsis causes micro clots to form. Do they have DIC? Are they in a hyper-coaguable state right now? Do they have cancer? Lots of variables to sift through to determine the etiology of the facial swelling.

You know, the facial swelling may not even be due to a clot, it could be due to a blockage of lymph fluid.

[Chaserr]

I'm kind of at a loss for words. Indwelling TpA and infusing TpA and completely different therapies as mentioned above. if the clot is INSIDE of the port then there would be no facial swelling and would require indwelling TpA which is anywhere from 30-120 minutes on indwelling. Now if for some reason the line CAUSED a venous thrombus of some sort then transfer to an ICU and infusion of TpA would be an option. Facial swelling could be from literally hundreds of etiologies, unless they had solid proof of a clot via sonogram results then they would have to go back to the drawing board and figure out what's going on...

[emtb2rn, BSN, RN, EMT-B]

For clogged ports we can use 2mg tpa, inject, let sit at least 30 minutes, aspirate/waste, flush.