Is Cathflo (alteplase) used for clearing occlusions in feeding tubes?

Cathflo (Alteplase) for Feeding Tube Occlusions

Cathflo (alteplase) is not indicated for clearing feeding tube occlusions; it is specifically used for central venous catheter occlusions. Based on the available guidelines, alteplase is recommended for restoring patency to occluded central venous access devices (CVADs), not feeding tubes 1.

Evidence for Cathflo Use in Central Venous Catheters

• Alteplase (Cathflo) is the recommended agent for treating thrombus-occluded central venous catheters, with strong evidence supporting its efficacy and safety 1.
• The COOL and COOL-2 trials demonstrated that alteplase restored patency to 74% of occluded venous catheters compared to 17% in the placebo arm 1.
• The Cathflo Activase Pediatric Study showed an 82.9% cumulative rate of catheter function restoration after two doses of alteplase in children with no major bleeding events 1, 2.
• Alteplase doses of 0.5-2 mg instilled into CVC lumens with dwell times of 30-240 minutes have shown efficacy ranging from 50-90% 1, 3.

Recommended Approaches for Feeding Tube Occlusions

For feeding tube occlusions, different approaches are recommended:

• Pancreatic enzyme solutions have been shown to be effective in clearing formula-related occlusions in feeding tubes with a 96% success rate when water alone fails 4.
• Proper medication administration through feeding tubes includes:
  • Using liquid medications when possible 5
  • Administering drugs individually through the feeding tube 1
  • Flushing the tube with 30 mL of water before, between, and after each drug administration 1
• Mechanical occlusion clearing devices have demonstrated 93% success in clearing feeding tube occlusions compared to 20% with warm water flushes and 33% with enzyme treatments 6.

Important Considerations and Pitfalls

• Mixing medications before administration through feeding tubes should be avoided due to potential drug-drug interactions 1.
• Drug-formula interactions can occur with certain medications (e.g., phenytoin binding to enteral formula or polyurethane tubes) 1.
• The site of the feeding tube tip affects drug delivery and efficacy; for example, duodenal administration may reduce bioavailability of certain drugs compared to gastric administration 1.
• Tablet impaction, knotted feeding tubes, and formula clots are common causes of feeding tube occlusions that require specific management approaches 4.

Conclusion for Clinical Practice

When managing feeding tube occlusions, clinicians should use appropriate methods such as pancreatic enzyme solutions or mechanical clearing devices rather than Cathflo, which is specifically designed and FDA-approved for central venous catheter occlusions 1, 4, 6.