Alteplase for the management of occluded central venous access devices: safety considerations.

Central venous access device (CVAD) dysfunction, with loss of patency because of thrombotic occlusion, has been reported to be the most common complication in central lines, even more common than catheter-related infection (Moureau, Poole, Murdock, Gray, & Semba, 2002). Occlusion of CVADs can cause life-threatening treatment delays, patient discomfort, infection, and the need for catheter removal and replacement. Alteplase (Cathflo Activase, Genentech, Inc.) is the only thrombolytic approved by the U.S. Food and Drug Administration (FDA) to restore catheter function as assessed by the ability to draw blood. Numerous studies have demonstrated the efficacy of alteplase for catheter clearance, along with a low incidence of complications (Semba et al., 2002; Shen et al., 2003). Although the incidence of complications is low, knowledge of safety precautions and considerations for special populations can help healthcare professionals to prevent unnecessary problems.