From the FDA Drug Label
Catheter dysfunction may be caused by a variety of conditions other than thrombus formation, such as catheter malposition, mechanical failure, constriction by a suture, and lipid deposits or drug precipitates within the catheter lumen. Because of the risk of damage to the vascular wall or collapse of soft‑walled catheters, vigorous suction should not be applied during attempts to determine catheter occlusion. Excessive pressure should be avoided when Cathflo Activase is instilled into the catheter.
You should not use Cathflo (alteplase) in soft-walled catheters due to the risk of collapse. Additionally, catheters with mechanical failure, constriction by a suture, lipid deposits, or drug precipitates within the catheter lumen should not be used with Cathflo. 1
From the Research
Cathflo (alteplase) should not be used in catheters with mechanical defects, infected catheters, or those used for hemodialysis, as well as in patients with known hypersensitivity to alteplase or active internal bleeding. When considering the use of Cathflo, it is essential to assess the type of catheter and its condition. According to the most recent and highest quality study available, 2, alteplase is safe and effective for restoring patency in midline catheters, but its use in other types of catheters, such as those for hemodialysis, may require caution due to potential interference with the dialysis process, as noted in 3.
Key considerations for the use of Cathflo include:
- Avoiding its use in catheters with mechanical defects such as cracks, leaks, or ruptures, as the medication may leak into surrounding tissues.
- Not using Cathflo in patients with known hypersensitivity to alteplase or any components of the formulation.
- Exercising caution with catheters in patients with active internal bleeding, recent surgery, or other conditions where bleeding risk is elevated, as alteplase is a thrombolytic agent that dissolves blood clots by activating plasminogen to plasmin.
- Verifying catheter integrity before administering Cathflo to ensure patient safety, as emphasized by the need for safe and effective management of occluded catheters 4, 5.
Given the potential risks and benefits, the decision to use Cathflo should be made on a case-by-case basis, prioritizing patient safety and the integrity of the catheter. The most recent study 2 supports the safety and efficacy of alteplase in midline catheters, but it is crucial to consider the specific context and catheter type when making treatment decisions.