Purpose. The purpose of this trial was to confirm safety and efficacy with thrombolytic use on complete and partially occluded central catheters using alteplase for the home care population. This trial attempts to provide additional evidence for the safe and effective use of a thrombolytic agent for catheter clearance, specifically with home care patients. Method. Patients were eligible for inclusion if (1) blood could not be withdrawn for partial occlusion or (2) blood could not be withdrawn and inability to flush presented with complete occlusion. Through an established Protocol, using the negative-pressure technique, nurses administered alteplase, 1mg/1 cc concentration, to home care patients who met inclusion criteria. Instillations were repeated at 20-minute intervals for up to three repetitions, if needed, with the third instillation remaining overnight. Results. Instillation of alteplase was successful in clearing catheter thrombotic occlusions in 66. 7% of patients studied in this outpatient population without thrombolytic events or drug related adverse effects. Conclusions. The authors confirm that catheter occlusions can be safely resolved in the alternate care/home care setting using established negative-pressure protocols. Although overnight dwell was used successfully and unsuccessfully in this trial without adverse effects, the small sample size does not Provide adequate definitive conclusions.

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