From the Guidelines
Yes, Cathflo (alteplase) can be used to clear occlusions in both peripheral and central venous catheters (CVCs). The standard dose is 2 mg in 2 mL (1 mg/mL) instilled into the occluded catheter lumen. For adult patients, the maximum dose is 2 mg per lumen, while pediatric patients typically receive a dose based on the estimated internal volume of the catheter (not to exceed 2 mg) 1. After instillation, the solution should dwell in the catheter for 30 minutes to 2 hours, after which an attempt should be made to aspirate the clot and solution. If the occlusion persists, a second dose with the same dwell time may be administered. Cathflo works by activating plasminogen to plasmin, which breaks down fibrin clots that cause catheter occlusions. This thrombolytic agent is specifically FDA-approved for restoring function to central venous access devices and has demonstrated effectiveness rates of 80-90% in clearing thrombotic occlusions 1.
Some key points to consider when using Cathflo include:
- Following aseptic technique to minimize the risk of infection
- Verifying catheter placement before administration to ensure the solution is delivered to the correct location
- Monitoring for potential adverse effects such as bleeding or hypersensitivity reactions, although these are rare with the localized catheter-directed application 1
- Considering alternative treatments, such as irrigation with saline or other solutions, if Cathflo is not effective 1
- Being aware of the potential for repeated doses to be necessary if patency is not restored after the initial dose 1
It's also important to note that Cathflo is not the only option for clearing occlusions in CVCs, and other treatments, such as urokinase or recombinant urokinase, may also be effective 1. However, based on the available evidence, Cathflo is a safe and effective option for restoring patency to occluded CVCs.
From the FDA Drug Label
Cathflo® Activase® (Alteplase) is indicated for the restoration of function to central venous access devices as assessed by the ability to withdraw blood.
- Yes, Cathflo (alteplase) can be used to clear an occlusion on a central venous catheter (CVC) line, as it is indicated for the restoration of function to central venous access devices 2.
- However, the label does not explicitly mention peripheral venous catheters.
- It is essential to follow the precautions and guidelines outlined in the drug label to minimize the risk of adverse reactions, such as bleeding and infection 2.
From the Research
Use of Cathflo on a Line
- Cathflo (alteplase) can be used to clear an occlusion on a peripheral or central venous catheter (CVC) line, as demonstrated in several studies 3, 4, 5, 6, 7.
- The safety and efficacy of alteplase for restoring function in occluded central venous catheters have been established in various patient populations, including adults and children 3, 5, 7.
Efficacy of Alteplase
- Studies have shown that alteplase is effective in restoring flow to occluded central venous access devices, with success rates ranging from 75% to 87% after one or two doses 3, 5.
- The use of alteplase has been found to be safe and effective in pediatric patients, with a cumulative rate of restoration of CVAD function of 82.9% after serial administration of a maximum of two instillations of alteplase 7.
Safety of Alteplase
- The primary safety endpoint of intracranial hemorrhage (ICH) within 5 days of treatment was found to be 0% in several studies 3, 5, 7.
- Serious adverse events were rare, and no cases of death, major bleeding episodes, or embolic events attributable to treatment were reported in the studies reviewed 3, 5, 7.
Clinical Applications
- Alteplase can be used to treat occlusions in various types of central venous catheters, including single-, double-, and triple-lumen catheters and ports 3, 5.
- The use of alteplase has been found to be effective in restoring patency to occluded central venous access devices in infants and children, with no adverse events noted within 24 hours after treatment 6.