1. ___ Appropriate catheter tip position has been confirmed on recent chest radiograph or SVC gram. Fibrin sheath or thrombus is present.
2. ___ Patient weighs greater than 30 kg and has no contraindication to use of thrombolytic agents.
- Active internal bleeding or
- Anyone who has had any of the following within 48 hours: surgery, obstetrical delivery, percutaneous biopsy of viscera or deep tissues, or puncture of non-compressible vessels.
- Thrombocytopenia or other hemostatic defects.
3. The patient has a ____ -lumen catheter or port.
4. Infusion will be performed through ____ port(s) labeled proximal (red) / distal (blue) [mark].
5. For each port to be infused, mix the following thrombolytic solution of Cathflo Activase 1 mg/mL:
- Aseptically withdraw 2.2 mL of Sterile Water for Injection, USP. Do not use Bacteriostatic Water for Injection..
- Inject the 2.2 mL of Sterile Water for Injection, USP, into the Cathflo Activase vial, directing the diluent stream into the powder. Slight foaming is not unusual; let the vial stand undisturbed to allow large bubbles to dissipate
- Mix by gently swirling until the contents are completely dissolved. Complete dissolution should occur within 3 minutes. DO NOT SHAKE. The reconstituted preparation results in a colorless to pale yellow transparent solution containing 1 mg/mL Cathflo Activase at a pH of approximately 7.3.
- Cathflo Activase contains no antibacterial preservatives and should be reconstituted immediately before use. The solution may be used for intracatheter instillation within 8 hours when stored at room temperature.
- Withdraw the contents of the vial and inject into 50cc of NS.
6. Infuse the solution(s) through the ordered port(s) over 1 hour.
7. Aspirate the treated port(s).
- If functioning well then pack with heparinized saline (1000 units/cc) to volume specific for catheter.
- Patient may be discharged.
8. If catheter does not aspirate well pack the port(s) with CathFlo 2mg/ml and discharge patient.
9. Patient should wait two hours minimum before using the catheter. The catheter should be aspirated fully before use if possible.
9. Notify M.D. if catheter did not aspirate well at time of discharge. If the catheter does not work in the clinical setting additional intervention may be required (stripping, changing, repostioning).
