954

Abstract

Introduction: Alteplase (recombinant tissue plasminogen activator) is the primary therapeutic option to noninvasively salvage an occluded catheter due to thrombus. The use of alteplase as a local instillation (dwell) for clearing partial occlusions in central venous catheters is well documented in the literature; however, there is a paucity of information published regarding the use of continuous infusions. The purpose of this study was to evaluate the efficacy and safety of continuous low-dose alteplase infusions to clear partially occluded catheters. Hypothesis: The authors hypothesized that the use of continuous low-dose alteplase infusions was both effective and safe for clearance of partially occluded central venous catheters in pediatric patients. Methods: The medical record of pediatric intensive care unit patients who received a low-dose alteplase infusion as the primary treatment for a partial catheter occlusion was retrospectively reviewed for efficacy and safety. All types of pediatric central venous catheters were included. The typical alteplase regimen was to administer 0.1 mg/kg (max 2 mg) of alteplase in 25 mL of 0.9% sodium chloride over 3 hours. Efficacy was defined as documentation of positive blood return from the catheter at the conclusion of the alteplase infusion. Physician, nursing, and radiology documentation and laboratory values were reviewed to assess for bleeding events. Results: 85 low-dose alteplase continuous infusions were used throughout the study time period. 71 of 85 (84%) alteplase infusions resulted in an initial positive blood return from the catheter. Only 1 catheter that initially failed to resolve was re-dosed with alteplase within 24 hours of the first dose, resulting in positive blood return (combined efficacy of 85%). No bleeding events were attributed to the alteplase infusion. Conclusions: Overall, 72 central venous catheter lumens with partial occlusions were salvaged with low-dose alteplase infusions, supporting the efficacy of this practice. No adverse events due to alteplase were identified, supporting the safety of this practice. The use of an infusion may be of benefit to avoid a bolus of alteplase if the dwell is unsuccessful and offer potential cost savings.