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3. The concentration of alteplase to be used will be 1 mg/mL.
4. The volume (dose) instilled is subject to weight-adjusted maximum doses.
a. When the maximum dose (in mg) is reached and the amount (mL) is insufficient to completely reach the end of the catheter, then normal saline (0.9% NaCl injection) will be added to the alteplase to complete the required volume (see attached Table).
b. Maximum single doses suggested are outlined below.
c. A maximum single dose of 2 mg (per lumen) should not be exceeded for any patient.
Per Lumen – Maximum Dose per Single Dose
< 2 Kg
2 to < 10 Kg
10 to < 30 Kg
> 30 Kg
5. For a Dual Lumen line, instill a single maximum dose in each lumen. If catheter patency is not achieved after two hours, wait 24 hours to repeat the dose. It is best to treat both lumens for a thrombotic occlusion as fibrin can eventually affect both lumens. If one lumen must be used for infusion, treat with alteplase as soon as possible.
Deb Bruene, RN, MA, CPHON
CWS Nursing – SFCH 112323
Nursing Practice Leader- Pediatric Pain Management
University of Iowa Stead Family Children’s Hospital
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I’m reaching out to see what the practice of TPA dosing is at other institutions. Currently we base our dosing on 110% of the internal volume of the catheter. In our policy, we do list all the catheter used in the organization and what the TPA volume should be. To make life easy for our staff, we want to convert to a weight based dosing. This way the volume would be standardize and less confusing for staff. Is anyone doing weight based TPA dosing, I would love to hear from you. Thank you!
—————————— Andrea Omsberg BSN, RN, CPHON Hematology/Oncology Inpatient Nurse Educator Rady Children’s Hospital San Diego, CA ——————————