title: Intraluminal Volume Dose Alteplase for the Clearance of Occluded Peripherally Inserted Central Catheter Lines at a Long-Term Acute Care Hospital: Efficacy and Economic Impact.
abstract: OBJECTIVE
  To evaluate the efficacy and economic impact of a maximum of 2 doses of intraluminal volume 1 mg/1 mL dose alteplase for the clearance of occluded peripherally inserted central catheter (PICC) lines at a long-term acute care hospital (LTACH).
  
  
  METHODS
  Open-label, nonrandomized quasi-experimental trial taking place over a 3-month period from December 2013 to March 2014. Patients had a standing order of either standard (2 mg/2 mL) or intraluminal volume (1 mg/1 mL) dose alteplase entered for any potential occlusions. The primary efficacy outcome was restored line patency after a maximum of 2 doses of alteplase. Secondary efficacy outcomes included restored patency after 1 dose of alteplase, reocclusion rate, mean time to reocclusion, and mean number of occlusions per patient.
  
  
  RESULTS
  A total of 168 patients were enrolled into the study (intraluminal volume, n = 54; standard, n = 114) and a total of 270 occlusions were recorded; 90 received intraluminal volume dose alteplase and 180 received the standard dose. The primary efficacy endpoint was 93.3% for the intraluminal volume dose group and 94.4% for the standard dose group. Secondary outcomes were similar between groups. The average cost per dose was $123.77 and $60.62 for the standard and intraluminal volume dose alteplase groups, respectively.
  
  
  CONCLUSIONS
  For the clearance of occluded PICC lines at our LTACH, there was no statistical difference in the efficacy of a maximum of 2 doses of intraluminal volume dose alteplase versus the standard dose. Use of intraluminal volume dose alteplase was found to be significantly more cost-effective.
authors.affiliation: PGY-1 Pharmacy Resident, Department of Pharmacy, HealthEast Bethesda Hospital , St. Paul, Minnesota .
authors.forename: Stephen P
authors.initials: SP
authors.lastname: Sapienza
authors.affiliation: Director of Pharmacy, Residency Program Director, Department of Pharmacy, HealthEast Bethesda Hospital , St. Paul, Minnesota .
authors.forename: Darrin R
authors.initials: DR
authors.lastname: Ciaschini
keywords: alteplase; intraluminal volume; long-term acute care hospital; peripherally inserted central catheter line