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8/16/2000

Advice Available on Clearing Clotted Catheters

Cheryl A. Thompson

Representatives from several health care organizations and Genentech Inc. have developed a consensus statement on the use of alteplase to restore function in clot-occluded catheters.

The statement was developed in response to the ongoing unavailability of urokinase, the only thrombolytic agent officially marketed in this country for the clearance of clots in venous-access devices. With urokinase supplies depleted or nearly gone, clinicians have turned to using alternative thrombolytic agents, including alteplase. 

In brief, the consensus statement suggests that alteplase 1 mg/mL can safely and effectively restore function in clot-occluded catheters. The typical dwell time for alteplase in an occluded venous-access device is 30 to 120 minutes. If necessary, a second dose of alteplase can be given after removal of the first one. 

The consensus statement was developed during a one-day multidisciplinary conference hosted in January by the National Association of Vascular Access Networks (NAVAN) through an educational grant from Genentech, maker of alteplase. Barbara T. McKinnon, Pharm.D., BCNSP, of Memphis, Tenn.-based Nova Factor Inc., represented ASHP at the conference. 

NAVAN said that a monograph describing the conference proceedings will appear in the summer 2000 issue of the network's Journal of Vascular Access Devices. 

The results of a pharmacist-led study on the use of alteplase to clear clot-occluded catheters will appear in a June issue of the American Journal of Health-System Pharmacy (AJHP). Already published in AJHP is information on the bioactivity of cryopreserved alteplase solutions.