Alteplase with blocked central venous access device (Paediatric Formulary)

Audience

• Highland HSCP only
• Paediatrics only

Indication

• Alteplase is a thrombolytic used for unblocking central lines.
• Lines may be:
  • Completely blocked: unable to flush or withdraw.
  • Partially blocked: flushed but cannot bleed back.
• Alteplase can be used in both scenarios. 
• Alteplase must be prescribed on the drug chart.

Supply

• Actilyse Cathflo 2mg powder for solution for injection and infusion.
• Use immediately after reconstitution. 
• Store in the original package in order to protect from light. 
• Store in a refrigerator (2 to 8°C).

Preparation

Administer alteplase 2mg per lumen (for patients >30kg):

• Reconstitute alteplase (Actilyse Cathflo) 2mg vial with 2.2mL water for injections to produce a 1mg/mL solution.  Gently swirl the vial; do not shake.  Avoid vigorous agitation to prevent foam formation.
• Draw up 2mL (2mg) from reconstituted vial into a syringe and inject into affected lumen(s).  Clamp line and leave for 30 minutes.
• If the line is not flushing, then attempt to instil the alteplase by attaching the syringe, drawing back and then releasing the plunger and repeat this multiple times.  Do not attempt to force the alteplase into a blocked line.
• After 30 minutes of dwell time, assess line function by attempting to aspirate blood.
  • If line is functional, aspirate 4 to 5mL of blood, remove alteplase and residual clot, and gently irrigate the catheter with sterile sodium chloride 0.9% using a push/ pause technique.
• If line is not functional, leave for a further 90 minutes (total of 2 hours from initial dose).  Assess line function by attempting to aspirate blood.  If line is functional, aspirate 4 to 5ml of blood, remove alteplase and residual clot, and gently irrigate the catheter with sterile sodium chloride 0.9% using a push/pause technique and use line as usual.
• If line is still blocked after 2 hours, repeat injection of a further 2mg alteplase according to instructions above) and leave for a further 2 hour period as detailed above.