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Alteplase for the treatment of midline catheter occlusions: a retrospective, single-cohort descriptive study

21 July 2022
Volume 31 · Issue 14



Despite the increasing popularity of midline catheters, data on the use of alteplase for restoring midline catheter patency is scarce.


This study aimed to evaluate off-label use of alteplase for midline catheter occlusions.


Adults who received alteplase into a midline catheter between January 2015 and May 2018 within a multi-hospital health system were included in this study. The primary outcome was restoration of infusion or withdrawal function from at least one lumen of a treated midline catheter.


Following alteplase administration, withdrawal function was restored in 47% (25/53) of occlusion events, infusion function was restored in 65% (11/17) of complete occlusion events, and infusion or withdrawal function was restored in 58% (31/53) of occlusion events. Only 34% (17/50) of catheters were replaced because of malfunction. Local bleeding was documented in 9% (n=5) of occlusion events after alteplase administration.


Most midline catheter occlusions treated with alteplase demonstrated restoration of infusion or withdrawal function.

In response to increasing regulatory pressure to reduce central line-associated bloodstream infections, there has been a transition in the US away from the use of peripherally inserted central catheters (PICCs) and central venous catheters (CVCs) (Pathak et al, 2015; 2018). Midline catheters are associated with a lower incidence of device-related bloodstream infections than PICCs and CVCs and have gained popularity as alternative peripheral venous access devices for infusion therapies and frequent phlebotomy for up to 28 days (Chopra et al, 2015; Adams et al, 2016).

Previous studies reported that midline catheter occlusions occur at a rate of 2%–6%, but they did not evaluate management strategies for midline catheter occlusions (Campagna et al, 2018; Chopra et al, 2019; Tripathi et al, 2021). Therefore, limited research exists regarding the management of midline catheter occlusions.

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