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  1. Hawes, Michelle L. DNP, RN, CRNI(R), VA-BC


Maintaining and restoring patency in midline catheters has been a significant issue in the hospitalized patient requiring a multitude of infusates and frequent blood specimen collection. Currently, clinicians may not use this device as often as clinically indicated because they lack an approved intervention to treat thrombotic occlusions. The purpose of this research was to show evidence that alteplase, a US Food and Drug Administration-approved thrombolytic for central vascular access devices, is a safe and effective thrombolytic for midline catheters. A prospective open label study of 497 midline catheters was conducted from July 2018 to December 2018. Of those studied, 112 devices were treated with 1 mg of alteplase, and 109 had patency restored with 1 dose. None of the 112 patients had a major adverse event, and only 1 minor event was recorded and was resolved without removal of the midline catheter. Treating occluded central vascular access devices with 2 mg of alteplase has been safe and effective since 2001. With this research, safety and efficacy appears to be established for 1 mg of alteplase, repeat times 1 mg if necessary, in midline catheters. With the option to treat patients with occluded midline catheters rather than replace, clinicians can reduce cost, increase patient satisfaction, and preserve vein health.