UMEM Educational Pearls

Category: Critical Care

Title: Catheter Occlusion - Correction

Keywords: central venous catheter, tissue plasminogen activator (PubMed Search)

Posted: 12/9/2008 by Mike Winters, MD (Emailed: 12/11/2008) (Updated: 8/11/2020)
Click here to contact Mike Winters, MD

My math may appear incorrect, however, I mistakenly left out that the protocol may be repeated once thereby giving up to a total of 4 mg of tPA.

Central Venous Catheter Occlusion

  • Many of us care for patients that present with pre-existing CVCs
  • Catheter occlusion is the most common complication associated with CVC
  • Thrombosis is the most common cause of obstruction of CVCs
  • Thrombosis is often be due to insoluble precipitates; meds such as diazepam, digoxin, phenytoin, and TMP-SMX can cause these precipitates
  • Local instillation of a thrombolytic agent (tPA) can be effective in restoring CVC patency
  • One protocol for use of tPA in CVC occlusion is to:
    • reconstitute a 50 mg vial with 50 mL sterile water (1 mg/mL)
    • draw up 2 mL in a 5 cc syringe and inject into the CVC - total tPA dose 2 mg
    • leave in place for approximately 2 hours
    • attempt to flush the CVC with a saline solution
  • If the catheter remains obstructed, a new CVC should be placed at a new site
  • The total drug dose in this regimen (4 mg) is too small to cause systemic thrombolysis