UMEM Educational Pearls

Title: Catheter Occlusion - Correction

Keywords: central venous catheter, tissue plasminogen activator (PubMed Search)

Posted: 12/9/2008 by Mike Winters, MD (Emailed: 12/11/2008) (Updated: 4/1/2023)
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My math may appear incorrect, however, I mistakenly left out that the protocol may be repeated once thereby giving up to a total of 4 mg of tPA.

Central Venous Catheter Occlusion

Many of us care for patients that present with pre-existing CVCs
Catheter occlusion is the most common complication associated with CVC
Thrombosis is the most common cause of obstruction of CVCs
Thrombosis is often be due to insoluble precipitates; meds such as diazepam, digoxin, phenytoin, and TMP-SMX can cause these precipitates
Local instillation of a thrombolytic agent (tPA) can be effective in restoring CVC patency
One protocol for use of tPA in CVC occlusion is to:
- reconstitute a 50 mg vial with 50 mL sterile water (1 mg/mL)
- draw up 2 mL in a 5 cc syringe and inject into the CVC - total tPA dose 2 mg
- leave in place for approximately 2 hours
- attempt to flush the CVC with a saline solution
If the catheter remains obstructed, a new CVC should be placed at a new site
The total drug dose in this regimen (4 mg) is too small to cause systemic thrombolysis