title: Efficacy of Reducing Alteplase Dose to Restore Patency in Nonhemodialysis Central Vascular Access Devices.
abstract: Central line-associated bloodstream infections (CLABSIs) are preventable through vigilant and thorough care. When CLABSIs occurred at a facility in Southwest Arizona, the root cause analysis discovered that declotting agents, such as alteplase, were not given routinely when nonhemodialysis (non-HD) central vascular access devices (CVADs) lacked blood return. A PICO question was developed that guided the review of literature and central line care standards of practice: In the adult patients with non-HD central lines, what medications are currently recommended to restore patency? As a result of this project, our facility instituted a new protocol using a reduced dose of alteplase to restore patency to non-HD CVADs.
authors.affiliation: Dignity Health-St. Joseph's Hospital and Medical Center, Phoenix, Arizona (Dr Plohal) and Banner University Medical Center-Phoenix, Phoenix, Arizona (Dr Schiller). Ann Plohal, PhD, APRN, ACNS-BC, CRNI®, works at Dignity Health-St. Joseph's Hospital and Medical Center, Phoenix, Arizona. Krishna Schiller, PharmD, works at Banner University Medical Center-Phoenix, Phoenix, Arizona.
authors.forename: Ann
authors.initials: A
authors.lastname: Plohal
authors.forename: Krishna
authors.initials: K
authors.lastname: Schiller
mesh_terms: D001130:Arizona; D055499:Catheter-Related Infections / Q000517:prevention & control; D062905:Central Venous Catheters; D055317:Evidence-Based Practice; D005343:Fibrinolytic Agents / Q000008:administration & dosage / Q000627:therapeutic use*; D006801:Humans; D010959:Tissue Plasminogen Activator / Q000008:administration & dosage / Q000627:therapeutic use*; D062666:Vascular Access Devices / Q000009:adverse effects*
chemical_list: D005343:Fibrinolytic Agents; D010959:Tissue Plasminogen Activator