OK I will outline the syringe method as this is my favorite as weel as our team favorite
1. Assess the catheter to determine the level of dysfunction and the possible cause. What is the line being used for? Was there a recent blood draw? How long has the line been in place? Does the line have a history of dysfunction? it will always help to get his brief history b/c if you can determine that it is a precipitate the Tpa will not work. If there was an am blood draw…it may be caused by blood clotting in the lumen. You get the idea. Remember that a PWO (persistant withdrawl occlusion) defined as an ability to easily instill but not withdraw should also be treated. A lumen of a CVC should never be left occluded as this puts a patient at an increased risk for infection…attempts to clear it (with a thrombolytic an agent to treat a precipitate) should be made or the catheter removed.
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2. Once you have determined that you want to try Tpa this is wha to do:
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a. reconstitute the Tpa with 2.2 ml sterile water ( make sure it is SW and nothing else) Do not shake
b. Draw up the dose in a 10 ml syringe
c Instill this at the hub or though the needleless cap. I prefer hub to hub as this eliminates the possibility of a cap problem. Cleanse the hub or cap with a 15 sec alcohol scrub and attach the syringe. IF unable to instill b/c you have a complete occlusion withdraw the 10 ml syringe back to the 6-8 ml mark keep doing this several times and then try to instill a little (NEVER Force it). You may have to pull back multiple multiple times before you can get a little in. Once you get a liitle in the floodgates open up and you can get the rest in. Personally I find it is easier to get the drug in with silicone catheters as compared to polyurethane but be careful not to push to hard on the silicone catheters as you can make pinholes anywhere along the catheter or damage the tails.
d.Once you get the 2 mg in label the line….tpa in line do not use.
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e return in 30 minutes and check for results. It has beeb effective if you are able to easily withdraw blood. If it is still sluggish push it back in. You can check every 30 min if you want but if the line is not needed right away I tend to to leave it for another 90 minutes
f. Once you have established a good blood return…..withdraw 5-10 ml blood and flush with 10-20 ml normal saline using a push pause pulsatile flush then a final flush of Heparin if you use it. re-apply cap if needed.
g A repeat dose may be needed.
I hope this is a better answer for you and if any more ?s I would be happy to share my experiences
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