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GOOD SHEPHERD MEDICAL CENTER POLICY Division: Clinical Effective Date: March 15, 2009 Page 1 Department: Nursing Date/Historical File: March 12, 2008 June 12, 2007 August 7, 2003 October 1998 VP/Committee Approval: Nursing P&P 11/08 Patient Care 03/09 Exec. 04/09 Subject: Declotting of a Central Catheter Using Cathflo Activase 2mg Purpose: To establish a protocol to restore the patency of an occluded central venous catheter with Cathflo Activase and in accordance with the Mosby procedure (Declotting of a Central Line). Policy: Cathflo is to be administered by an RN that has completed initial competency and updates as needed. Central Venous catheters appropriate for Cathflo Activase: o CVC’s (tunneled and non tunneled) o Implanted venous ports o Peripherally inserted central catheters (PICC) Cathflo Activase is indicated for the restoration of function to central venous catheters obstructed by clotted blood or a fibrin sheath. The obstruction may be partial or complete. Central venous catheter occlusion is defined by: o Difficulty flushing o Inability to draw at least 3mL of blood o Failure to infuse (complete occlusion) Notify the physician if a central venous catheter becomes occluded. Obtain an order for Cathflo Activase 2mg per port (times the number of ports occluded). May be repeated one time per port if necessary. Contraindications: Catheter patency may be impaired by circumstances other than a fibrin clot, such as catheter malposition, mechanical failure, lipid deposits, or drug precipitates. o Cathflo Activase is not effective in such cases Cathflo should not be administered to patients with a known hypersensitivity to Activase or any component of the formulation. Do not administer Cathflo if patient has any signs of infection such as redness, exudate, or warmth around catheter site. If you suspect an infection, notify the physician. Reference: Mosby’s Skills – Central Venous Access Devices: Declotting with Alteplase (Cathflo Activase), Extended Text Reviewed By: D. Tevebaugh, RN, PICC Reviewed by: K. Howard, MD, Radiologist Revised By: Denise Fussell, RN, PICC Denise Fussell, RN PICC Revised by: Heather Biddy, RN PICC 05/07 03/08 02/08 11/08 3/14