Intrapleural Fibrinolytic Instillation

Indications


Procedure

  • Order From Pharmacy: sterile preparation of tPA 2 mg in 25 mL of saline in 70 mL catheter tip syringe
  • Positioning: position patient in lateral position (side to be treated up)
  • Chest Tube Clamps: apply two blue plastic chest tube clamps approximately 3 inches and 6 inches from end of the chest tube
  • Disconnect Chest Tube: disconnect chest tube from pleurevac and hold chest tube end vertically
  • Release of Distal Chest Tube Clamp: release distal chest tube clamp
  • Instillation of tPA: instill part of tPA into chest tube (avoiding introduction of air)
  • Release of Proximal Chest Tube Clamp: release proximal chest tube clamp
  • Instillation of tPA: instill rest of tPA into chest tube (avoiding introduction of air)
  • Instillation of Sterile Saline (pulled from bag of IV saline): instill 25 ml of sterile saline into chest tube, using same technique with chest tube clamps
  • Reapplication of Chest Tube Clamps: reapply chest tube clamps and reconnect chest tube to pleurevac
  • Chest Tube to Water Seal: place chest tube to water seal x 2 hrs (with patient positioned with treated side down, as tolerated)
    • Return chest tube to suction after this 2 hr period

Complications

  • Hemorrhage
  • Infection
  • Pneumothorax

References

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