References

Adams DZ, Little A, Vinsant C, Khandelwal S The midline catheter: a clinical review. J Emerg Med. 2016; 51:(3)252-258 https://doi.org/10.1016/j.jemermed.2016.05.029

Bard Access Systems. PowerGlide Pro™ midline catheter. 2015. https://tinyurl.com/mwus8dpd (accessed 9 July 2022)

Blaney M, Shen V, Kerner JA Alteplase for the treatment of central venous catheter occlusion in children: results of a prospective, open-label, single-arm study (The Cathflo Activase Pediatric Study). J Vasc Interv Radiol. 2006; 17:(11 Pt 1)1745-1751 https://doi.org/10.1097/01.RVI.0000241542.71063.83

Bolton D Preventing occlusion and restoring patency to central venous catheters. Br J Community Nurs. 2013; 18:(11)539-540 https://doi.org/10.12968/bjcn.2013.18.11.539

Campagna S, Gonella S, Zerla PA The risk of adverse events related to extended-dwell peripheral intravenous access. Infect Control Hosp Epidemiol. 2018; 39:(07)875-877 https://doi.org/10.1017/ice.2018.79

Chopra V, Flanders SA, Saint S The Michigan Appropriateness Guide for Intravenous Catheters (MAGIC): results from a multispecialty panel using the RAND/UCLA appropriateness method. Ann Intern Med. 2015; 163:S1-S40 https://doi.org/10.7326/M15-0744

Chopra V, Kaatz S, Swaminathan L Variation in use and outcomes related to midline catheters: results from a multicentre pilot study. BMJ Qual Saf. 2019; 28:(9)714-720 https://doi.org/10.1136/bmjqs-2018-008554

Deitcher SR, Fesen MR, Kiproff PM Safety and efficacy of alteplase for restoring function in occluded central venous catheters: results of the cardiovascular thrombolytic to open occluded lines trial. J Clin Oncol. 2002; 20:(1)317-324 https://doi.org/10.1200/JCO.2002.20.1.317

Goossens GA Flushing and locking of venous catheters: available evidence and evidence deficit. Nurs Res Pract. 2015; 2015:1-12 https://doi.org/10.1155/2015/985686

Gorski LA, Hadaway L, Hagle ME, McGoldrick M, Orr M, Doellman D The 2016 Infusion Therapy Standards of Practice. Home Healthc Now. 2017; 35:(1)10-18 https://doi.org/10.1097/NHH.0000000000000481

Gorski LA, Hadaway L, Hagle ME Infusion Therapy Standards of Practice, 8th edition. J Infus Nurs. 2021; 44:(1S Suppl 1)S1-S224 https://doi.org/10.1097/NAN.0000000000000396

Hawes ML Assessing and restoring patency in midline catheters. J Infus Nurs. 2020; 43:(4)213-221 https://doi.org/10.1097/NAN.0000000000000376

Marino P The indwelling vascular catheter, 4th edn. Philadelphia (PA): Lippincott Williams & Wilkins; 2013

Navilyst Medical. Bioflo™ PICC with ENDEXO™ and PASV™ valve technology. 2012. https://www.flomedicalsales.com.au/wp-content/uploads/BIOFLO-PASV-Directions-For-Use.pdf (accessed 5 July 2022)

Pathak R, Patel A, Enuh H, Adekunle O, Shrisgantharajah V, Diaz K The incidence of central line-associated bacteremia after the introduction of midline catheters in a ventilator unit population. Infect Dis Clin Pract. 2015; 23:(3)131-134 https://doi.org/10.1097/IPC.0000000000000237

Pathak R, Gangina S, Jairam F, Hinton K A vascular access and midlines program can decrease hospital-acquired central line-associated bloodstream infections and cost to a community-based hospital. Ther Clin Risk Manag. 2018; 14:1453-1456 https://doi.org/10.2147/TCRM.S171748

Qin KR, Nataraja RM, Pacilli M Long peripheral catheters: is it time to address the confusion. J Vasc Access. 2019; 20:(5)457-460 https://doi.org/10.1177/1129729818819730

Ragsdale CE, Oliver MR, Thompson AJ, Evans MC Alteplase infusion versus dwell for clearance of partially occluded central venous catheters in critically ill pediatric patients. Pediatr Crit Care Med. 2014; 15:(6)e253-e260 https://doi.org/10.1097/PCC.0000000000000125

Reed M, Kerndt CC, Nicolas D Alteplase.Treasure Island (FL): StatPearls Publishing; 2022 https://www.ncbi.nlm.nih.gov/books/NBK499977/

Semba CP, Deitcher SR, Li X, Resnansky L, Tu T, McCluskey ER Treatment of occluded central venous catheters with alteplase: results in 1,064 patients. J Vasc Interv Radiol. 2002; 13:(12)1199-1205 https://doi.org/10.1016/S1051-0443(07)61965-4

Tripathi S, Kumar S, Kaushik S The practice and complications of midline catheters: a systematic review. Crit Care Med. 2021; 49:(2)e140-e150 https://doi.org/10.1097/CCM.0000000000004764

US Food and Drug Administration. 2001. https://www.accessdata.fda.gov/drugsatfda_docs/label/2001/altegen090401lb.pdf (accessed 9 July 2022)

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

21 July 2022
17 min read
Volume 31 · Issue 14

Abstract

Background:

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

Aims:

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

Method:

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.

Findings:

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.

Conclusion:

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.

Register now to continue reading

Thank you for visiting British Journal of Nursing and reading some of our peer-reviewed resources for nurses. To read more, please register today. You’ll enjoy the following great benefits:

What's included

  • Limited access to clinical or professional articles

  • Unlimited access to the latest news, blogs and video content