For many years, our IR physicians have been using a low dose alteplase infusion (2 mg in 100 mL over 3 hours) as salvage therapy to clear central lines when alteplase dwells fail. They’ve recently come to pharmacy asking if we can help convince nursing that it is safe to give this to patients on a Med/Surg unit instead of having to transfer them to an ICU bed or open the IR suite to give the infusion there. Our clinical assessment within clinical pharmacy, is that the low dose infusion is safe to give on a Med/Surg unit if an IR prescriber orders it after assessing the patient.
Brief questions for you:
Do you know if your providers are using low dose alteplase in this way?
If yes, do you allow this to be administered on Med/Surg units?
If yes, do you restrict ordering to IR providers?
If no to the first question, is there another salvage therapy in use at your facilities (other than changing the line out)?