Download Cathflo Activase (alteplase) use is supported by

Cathflo Activase (alteplase) use is supported by
professional guidelines
The Joint Commission advocates implementing evidence-based medicine practices1
The
practice of evidence-based medicine involves ongoing systematic review of best and most
• current
scientific research
2
— Multicenter randomized trials with stringent endpoints provide the highest level of evidence3
Guidelines support good catheter management, including catheter salvage
and use of an approved thrombolytic agent
Association/society
Guidelines
“The nurse should aspirate for a positive blood return from the
vascular access device (VAD) to confirm device patency prior to
administration of parenteral medications and solutions.”4
Infusion Nurses Society (INS)
“The instillation of low-dose alteplase is effective in restoring blood
flow....”4
“All infusion equipment and supplies shall be inspected for product
integrity before, during, and after use. If a product’s integrity is
compromised or the product is expired, it shall not be used.”4
Association for Vascular
Access (AVA)
“Catheter salvage is the preferred approach for managing
thrombosed catheters….”5
“Published data have suggested that the instillation of very low-dose
alteplase (recombinant t-PA) is…effective for the…restoration of
function in the treatment of thrombotic catheter dysfunction.”5
The Society for Healthcare
Epidemiology of America
and the Infectious Diseases
Society of America
(SHEA/IDSA)
“CVC insertion should be observed by a nurse, physician, or other
healthcare personnel who has received appropriate education…
to ensure that aseptic technique is maintained.”6
Oncology Nursing Society
(ONS)
“The use of alteplase for catheter occlusion has been found to be…
[an] effective thrombolytic agent.”7
American Association of
Critical-Care Nurses (AACN)
“Currently, t-PA (alteplase, Cathflo Activase) is the only thrombolytic
agent approved by the Food and Drug Administration for
reestablishing patency in thrombosed central catheters.”8
The Centers for Disease
Control and Prevention
(CDC)
“Do not routinely replace CVCs [or] PICCs [peripherally inserted
central catheters]…to prevent catheter-related infections.”9
“Do not routinely replace CVCs [central venous catheters]….”6
Please see Indication and Important Safety Information on reverse side.
www.cathflo.com
Cathflo Activase (alteplase) is integral in evidence-based
practices for treating thrombotically occluded catheters
a common complication of central venous access devices (CVADs), can
• Ccompromise
atheter occlusion,
patient care
10,11
each infusion, ensure catheter patency by assessing the catheter for a brisk, free-flowing
• Pblood
rior toreturn
*
4,12
• U se of Cathflo to treat a thrombotic occlusion may restore function
clinical trials, the most serious adverse events reported were sepsis, gastrointestinal
• Ibleeding,
n the Cathflo
and venous thrombosis
13
13
*According to the Oncology Nursing Advisory Board, brisk, free-flowing blood return is defined as blood
return of 3 mL in 3 seconds.12
Indication
Cathflo Activase (alteplase) is indicated for the restoration of function to central venous access devices
as assessed by the ability to withdraw blood.
Important Safety Information
Cathflo Activase should not be administered to patients with known hypersensitivity to alteplase or any
component of the formulation.
In clinical trials, the most serious adverse events reported after treatment were sepsis, gastrointestinal
bleeding, and venous thrombosis.
Certain causes of catheter dysfunction should be considered before treatment with Cathflo Activase
(ie, catheter malposition, mechanical failure, constriction by a suture and lipid deposits or drug
precipitates within the catheter lumen).
The most frequent adverse reaction associated with all thrombolytics in all approved indications is
bleeding. Caution should be exercised with patients who have any condition for which bleeding
constitutes a significant hazard.
Cathflo Activase should be used with caution in the presence of known or suspected infection in
the catheter.
Please see accompanying full Prescribing Information for additional Important Safety Information.
References: 1. Render ML, Brungs S, Kotagal U, et al. Evidence-based practice to reduce central line infections. Jt Comm J Qual Patient Saf. 2006;32(5):253-260. 2. Keckley PH.
Evidence-based medicine in managed care: a survey of current and emerging strategies. MedGenMed. 2004;6(2):56. 3. Sackett DL. Rules of evidence and clinical
recommendations on the use of antithrombotic agents. Chest. 1989;95(suppl 2):2S-4S. 4. Infusion Nurses Society. Infusion nursing standards of practice. J Infus Nurs.
2011;34(suppl 1):S1-S110. 5. Haire WD, Herbst SF. Highlights bulletin: consensus conference on the use of alteplase (t-PA) for the management of thrombotic catheter
dysfunction. J Vasc Access Devices. Summer 2000:1-8. 6. Marschall J, Mermel LA, Classen D, et al. Strategies to prevent central line-associated bloodstream infections in acute
care hospitals. Infect Control Hosp Epidemiol. 2008;29(suppl 1):S22-S30. 7. Camp-Sorrell D, ed. Access Device Guidelines: Recommendations for Nursing Practice and
Education. 2nd ed. Pittsburgh, PA: Oncology Nursing Society; 2004. 8. Criddle LM. Ask the experts. Crit Care Nurse. 2007;27(3):78-81. 9. O’Grady NP, Alexander M, Burns LA, et al.
Guidelines for the Prevention of Intravascular Catheter-related Infections, 2011. Centers for Disease Control and Prevention Web site. http://www.cdc.gov/hicpac/pdf/
guidelines/bsi-guidelines-2011.pdf. Accessed March 11, 2013. 10. McKnight S. Nurse’s guide to understanding and treating thrombotic occlusion of central venous access
devices. Medsurg Nurs. 2004;13(6):377-382. 11. Stephens LC, Haire WD, Kotulak GD. Are clinical signs accurate indicators of the cause of central venous catheter
occlusion? J Parenter Enteral Nutr. 1995;19(1):75-79. 12. Cummings-Winfield C, Mushani-Kanji T. Restoring patency to central venous access devices.
Clin J Oncol Nurs. 2008;12(6):925-934. 13. Cathflo Prescribing Information. Genentech USA, Inc.
www.cathflo.com
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Printed in USA.