title: Alteplase infusion versus dwell for clearance of partially occluded central venous catheters in critically ill pediatric patients.
abstract: OBJECTIVE
  To evaluate the efficacy and safety of alteplase infusions and alteplase local instillations (dwells) to clear partially occluded central venous catheters in critically ill children.
  
  
  METHODS
  Retrospective study.
  
  
  METHODS
  PICU in a single, tertiary care, academic children's hospital.
  
  
  METHODS
  Retrospective review of the medical records of all critically ill pediatric patients less than 18 years old who received an alteplase infusion or dwell as the treatment for a partial central venous catheter occlusion. The typical infusion regimen was to administer 0.1 mg/kg of body weight (maximum, 2 mg/dose) of alteplase in 25 mL of 0.9% sodium chloride over 3 hours. The standard dwell was to administer and aspirate alteplase in a 1 mg/mL concentration as a fixed dose as ordered by the prescriber (maximum, 2 mg/dose). Efficacy was defined as documentation of positive blood return from the catheter. Radiology reports, nursing and physician documentation, and laboratory values were reviewed to assess for bleeding events.
  
  
  METHODS
  None.
  
  
  RESULTS
  One hundred fifty occlusion events were included for analysis. Overall, 72 of 84 alteplase infusions (86%) and 53 of 66 alteplase dwells (80%) resulted in resolution of the lumen occlusion event as documented by positive blood return from the catheter after a maximum of two doses (p = 0.39). One major bleeding event occurred in each arm; both were deemed unlikely related to alteplase.
  
  
  CONCLUSIONS
  Alteplase infusions to clear partially occluded central venous catheters appear to be as efficacious as alteplase dwells in critically ill children. In occlusions treated with an infusion, more occlusions resolved in older and larger patients and in patients with catheters in place less than 7 days. In occlusions treated with a dwell, more occlusions resolved in smaller catheters. The safety profile for both infusions and dwells was acceptable for the pediatric critically ill population.
authors.affiliation: 1Department of Pharmacy, Dell Children's Medical Center of Central Texas, Seton Healthcare Family, Austin, TX. 2Department of Pharmacy, Medical University of South Carolina, Charleston, SC. 3Division of Pediatric Critical Care Medicine, Medical University of South Carolina, Charleston, SC.
authors.forename: Carolyn E
authors.initials: CE
authors.lastname: Ragsdale
authors.forename: Maggee R
authors.initials: MR
authors.lastname: Oliver
authors.forename: A Jill
authors.initials: AJ
authors.lastname: Thompson
authors.forename: Melissa C
authors.initials: MC
authors.lastname: Evans
mesh_terms: D061807:Catheter Obstruction; D002405:Catheterization, Central Venous / Q000295:instrumentation; D062905:Central Venous Catheters; D002648:Child; D002675:Child, Preschool; D016638:Critical Illness; D005260:Female; D005343:Fibrinolytic Agents / Q000008:administration & dosage* / Q000009:adverse effects; D006801:Humans; D007223:Infant; D007262:Infusions, Intravenous; D007322:Instillation, Drug; D008297:Male; D012189:Retrospective Studies; D013396:Suction; D010959:Tissue Plasminogen Activator / Q000008:administration & dosage* / Q000009:adverse effects
chemical_list: D005343:Fibrinolytic Agents; D010959:Tissue Plasminogen Activator