DRUG	SUPPLIED	DOSE	COMMENTS
ALTEPLASE (Paeds) (TPA; tissue plasminogen activator; Activase rTPA; Cathflo) Mechanism of action: Thrombolytic; recombinant enzyme which catalyzes conversion of plasminogen to plasmin Ref: Ref. 90,  149 Last update: 2019-01-24	Injection: 50 mg/vial Cathflo: 1 mg/mL (2 mL)	For Blocked Central Line: 1 mg/mL concentration is used.  Instill into each blocked lumen of CVC or implanted port (volume is dependent upon volume of the device in situ). -Instill 110% of catheter lumen volume (if known).  Maximum 2 mL  -If catheter lumen volume is unknown, instill 1 mL (weight < 30 kg) or 2 mL (weight  ≥ 30 kg) Dwell time is 2 hrs. Systemic Thrombolytic Therapy: To be given in intensive care areas only. 0.5 mg/kg/hr IV x 6 hrs Parapneumonic effusion : 4 mg/4 mL instilled into chest tube Q24H for total of 3 doses (if platelets >50,000)	Consult to hematology service is mandatory for systemic thrombolysis. For systemic therapy monitor fibrinogen (maintain > 1 g/L), PT, APTT, platelets (maintain >100,000) Risk of bleeding increases with increased duration of infusion. For detailed information refer to C&W Policies on: Clearing blocked central lines; Central Venous Catheter Occlusion; Systemic Thrombolytic Therapy; Parapneumonic effusions.   Standard Prescription: alteplase __mL instilled into each blocked lumen alteplase __mg/kg/hr IV infusion x __hours alteplase 4 mg/4 mL instilled into chest tube Q24H for 3 doses