Managing Thrombotic Occlusions – Clarification

Question: Our facility does not use stopcocks.   Your class only shows this method.

I thought the max dose of Cathflo was 4mg per day?  L.E.

Hello L.E.,

Thank you for your feedback on our Managing Thrombotic Occlusion online course, we will look at adding more content to the program. The process with the stopcock or one/two syringe is basically the same with a focus on aspiration and instillation of the thrombolytic, rather than pushing/forcing the thrombolytic into the catheter.  

There have been multiple research trials on Cathflo. The most notable were the COOL 1&2 trials and the CAPS trial for pediatrics. In these studies dosing was limited to two instillations. In another outpatient trial, supported through a Genentech grant, the PICCOLO II research used up to three instillations (negative pressure aspiration) with the last dose (if unsuccessful) left in overnight. This study, that I conducted as the principle investigator, was open label, FDA waiver drug study and within the published instructions for dosage originally issued by Genentech. Since most of the studies on Cathflo have been 2 instillations the brochures include this information.

I have attached a few of the studies and information to provide added details for you. Let me know if you have additional questions.

Genetech brochure – Cathflo-Dosing and Administration 

Genentech brochure FDA approved dosing with Cathflo Activase (alteplase) 2mg

Moureau, N. 2002 Using alteplase to clear occlusions Nursing 2002 32(1): 73

Moureau, N., Mlodzik, L., Pool, S., The Use of Alteplase for Treatment of Occluded Central Venous Catheters in Home Care: Clinical Investigations JAVA 10(3):p123-129

Alteplase FDA IFUs.pdf

Moureau, N., Thompson, B., Douglas, C., 1999 Multidisciplinary Management of Thrombotic Catheter Occlusions in Vascular Access devices JVAD 4(2):22-29

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