Alteplase...

whenever i have de-clotted a picc using alteplase, i instil the 2ml's into the clotted lumen, let it sit for a half hour, and then pull back 10 ml's. that should pull back the clot buster and enough blood so that you know you haven't left any in. true, it shouldn't have been left in the pt. but there was no need for the other nurse to snip at you.

jenn:wink2:

If a 2-mg dose of Cathflo is administered by bolus injection into the PICC the concentration of circulating drug would be insignificant but should be pulled out back when possible

whenever i have de-clotted a picc using alteplase, i instil the 2ml's into the clotted lumen, let it sit for a half hour, and then pull back 10 ml's. that should pull back the clot buster and enough blood so that you know you haven't left any in. true, it shouldn't have been left in the pt. but there was no need for the other nurse to snip at you.

jenn:wink2:

i did end up drawing back five ccs from each lumen before i left. maybe that helped. i don't know. i didn't really think it would do much harm to be honest.

I didn't think it would be that significant of a dose on a 500+lb patient. Anyhow, I'm looking at this TPA dosing chart and its says the normal initial bolus for putting a patient of 500+ pounds is 9mg. I didn't think 2mg would be that significant.

kind of had an a-ha moment. i was doing some research on the cathflo site and it states that..."because it has a short half-life, circulating plasma levels of cathflo are not expected to reach pharmacologic concentrations, even if a small quantity enters the bloodstream."

IMO, it's not about potential patient harm, it's more about performing the procedure correctly. When declotting a PICC, after you've let the TPA sit and dissolve the clot, you pull out the TPA. When I declot a PICC, the way I tell if it's declotted is by drawing back blood, so it's fairly impossible for me to accidently flush it into the patient. Waste that draw, then flush vigirously and change out the white caps.

I wouldn't fret about the potential patient harm because that's pretty much nonexistant, just understand that you performed the procedure incorrectly and move on and do it correctly next time.

Right. Got it.

So get some rest

Just an FYI, we generally leave the declot in for a minimum of 2 hours, check it, if the line still doesn't draw back, we leave it in for longer, and keep working with it until it's functional.

So get some rest

Just an FYI, we generally leave the declot in for a minimum of 2 hours, check it, if the line still doesn't draw back, we leave it in for longer, and keep working with it until it's functional.

Thanks, I looked that up on the Cathflo website. It said leave in for 30 minutes, then aspirate. If clot isn't resolved, wait 120 minutes then aspirate. If catheter is functional, aspirate 4-5cc if patient is greater than 10kg. Then irrigate cath with 0.9NS 10cc. Just irks me because she snipped at me in front of a completely alert patient.

Bah, I hate people who do that. It's entirely unprofessional on her part. If she has a problem with your practice, she should discuss it privately with you, not in front of a patient. That would have been the appropriate, professional response on her part. You might should politely ask her that when she believes you did something incorrectly that she take you aside and educate you away from the patient.

I had one line that was awful, I left the TPA for more hours than I can remember! It was declotted by the time I left, though!

Bah, I hate people who do that. It's entirely unprofessional on her part. If she has a problem with your practice, she should discuss it privately with you, not in front of a patient. That would have been the appropriate, professional response on her part.

I had one line that was aweful, I left the TPA for more hours than I can remember! It was declotted by the time I left, though!

I wanted to say..."well if you're so smart why didn't you get a TPA order from the doc yourself. I was doing you a favor so you wouldn't have to stick my patient for blood". :banghead: Frustrating it is. I'm having a drink and going to bed soon.

The nurse shouldn't have been "snippy" with you but I bet you will always remember how to declot a line in the future. Whenever we ask a patient the nursie question "how do you learn best.. written, demonstration, verbal... I always think --"I learn best by someone screwing up and getting chastised about it- usually me". As far as harm to the patient- consider this-would they let nurses instill the "clot buster" in a line going into the patient if it had the potential to cause serious harm if it got all the way into the patient?- no. At my hospital this is a nursing order- no doc required. If the hospital allows a nurse to give something without a MD ordering it it's got to be pretty benign.