Declotting Picc With Tpa

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How does one go about declotting a PICC with TPA?

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Specializes in OB, M/S, HH, Medical Imaging RN.
How does one go about declotting a PICC with TPA?

I don't know, I use Heparin Flush, I'd be interested to know myself.

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Hello, It's usually pretty easy. You instill about 2mls of TPA into the Picc and allow it to sit for about 30 minutes. You then draw back on the line and you can usually get a blood return. Works pretty well. Hope this helps.

Brenda

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Our policy is to use CathFlo (TPA), we use a 3 way stop-cock, one end to the PICC, one end to an empty 10 cc syringe, and one end to a CathFlo syringe. Draw back on the empty syringe, creating a vacuum in the picc line between the stop-cock and the clot, switch the stop-cock to the CathFlo and the TPA is sucked up to the clot. Let sit for 30 minutes, draw the clot back into the syringe. Repeat x1 for 2 hours if not successful.

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DOSAGE AND ADMINISTRATION Cathflo® Activase® (Alteplase) is for instillation into the dysfunctional catheter at a concentration of 1 mg/mL.

* Patients weighing >30 kg:

2 mg in 2 mL

* Patients weighing

110% of the internal lumen volume of the catheter, not to exceed 2 mg in 2 mL

If catheter function is not restored at 120 minutes after 1 dose of Cathflo Activase, a second dose may be instilled (see Instructions for Administration). There is no efficacy or safety information on dosing in excess of 2 mg per dose for this indication. Studies have not been performed with administration of total doses greater than 4 mg (two 2-mg doses).

Instructions for Adminstration

....

4. Cathflo Activase contains no antibacterial preservatives and should be reconstituted immediately before use. The solution may be used for intracatheter instillation within 8 hours following reconstitution when stored at 2–30°C (36–86°F).

No other medication should be added to solutions containing Cathflo Activase

Instillation of Solution into the Catheter

1. Inspect the product prior to administration for foreign matter and discoloration.

2. Withdraw 2 mL (2 mg) of solution from the reconstituted vial.

3. Instill the appropriate dose of Cathflo Activase (see DOSAGE AND ADMINISTRATION) into the occluded catheter.

4. After 30 minutes of dwell time, assess catheter function by attempting to aspirate blood. If the catheter is functional, go to Step 7. If the catheter is not functional, go to Step 5.

5. After 120 minutes of dwell time, assess catheter function by attempting to aspirate blood and catheter contents. If the catheter is functional, go to Step 7. If the catheter is not functional, go to Step 6.

6. If catheter function is not restored after one dose of Cathflo Activase, a second dose of equal amount may be instilled. Repeat the procedure beginning with Step 1 under Preparation of Solution.

7. If catheter function has been restored, aspirate 4—5 mL of blood in patients > 10 kg or 3 mL in patients

Any unused solution should be discarded.

http://www.gene.com/gene/products/information/cardiovascular/cathflo-activase/insert.jsp

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what will happen if you flushed the 2cc tpa?

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Your question is a bit unclear. Clearly you want to follow the manufactuers literature which is enclosed in the CathFlo Activase packaging.You absolutely do not want to go and attempt to flush a clotted line with Cath Flo. The stop cock method of administration is the acceptable method of choice (but of course you must follow institutional guidelines). Cath Flo dwell time is 120 minutes on the initial application. If the line still remains clotted a repeated dose is made to dwell after the initial dose is removed. I have had nurses allow Cath Flo to sit overnight. At this point the CathFlo has lost most of its potency and can be flushed through the catheter if it is allowing you to. Personally I would not do this and would still attempt to withdraw the dwelling dose.I would also not use this product if you have not been taught according to hospital policy. Also take into consideration lumen fill volume, device that is clotted, age and weight of patient.etc.A seasoned hands on teacher with experience using this product is the best advice I can give. Please do not draw up a dose and attempt to give the dose without following the proper steps. Also please reasearch a bit, it will bring a wealth of knowledge and peace of mind.

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