If we could continue the conversation of TPA I have two questions--
(1) Since I am unfamilar with the dose given for Acute MI--if the dose of TPA administered for catheter occlusion is 1/50th the dose given for AMI how many times is that 1mg dose in relationship to the dose for AMIA. A typical AMI dose is 100 mg. Therefore a Cathflo or 2 mg dose of tPA is 1/50th of the systemic thrombolytic dose, and a 1 mg dose is only 1% or 1/100th of a total systemic dose. Keep in mind that if nearly the entire dose goes in systemically because the occlusion is OUTSIDE the tip of the catheter, then the tPA is metabolized by the liver quickly; tPA ihas a half-life of 5- 7 minutes. If you repeat the dose 2 hours later, there is NO CUMULATIVE effect. At 2 mg, there is no systemic effect on the patient's coagulation system.(2) If there are no TPA "contraindications" how does one convince an MD that it is safe to give that 1mg dose for a patient with DICA. The key here is to weigh the risks versus the benefits. The patient with a severe coagulapathy obviously needs that CVAD, and a fully functioning one at that. Lack of blood return might mean inability to get labwork drawn, difficulty assessing catheter function, and an increased risk of CRBSI. The risk of bleeding with a 2 mg dose of Cathflo is NO GREATER than their inherent risk of bleeding due to their underlying disease or complications of their disease. It is MUCH SAFER to restore catheter patency than to either leave it partially occluded or to replace it.Answers from:Nadine Nakazawa, RNStanford HospitalThank you in advance for your insightsRobbin K. George RN
Vascular Access Resource
Alexandria Hospital Virginia
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