Chest Tube Management - How to give Intrapleural tPA & Domase - Instructions:
There is evidence to support the administration of tPA+DNAse simultaneously. (https://www.atsjoumals.org/doi/pdf/10.1513/AnnalsATS.201602-127OC )
However, you should give it separately if the pulmonary team states otherwise.
Step-by-step instructions:
1. tPA will arrive at bedside {it is only usable -30 mins after it arrives at bedside)
2. Tum off suction on chest tube
3. Tum the stopcock towards the PleurEvac {C) {the direction that the stopcock is pointing to= direction that it's blocking).
4. Administer the tPA {and Domase), observing usual sterile technique {dosage may vary based on pulmonary team recommendations)
5. Flush chest tube with 30cc sterile saline flush
6. Tum the stopcock towards the patient {A) to trap the tPA and domase in the patient's pleura
7. Wait 1 hour to allow the medication to work
- If you are asked to administer tPA & Domase separately, you can repeat Steps 3-7 with Dornase.
8. Tum the stop cock to the tPA port (B) & allow drainage from the lungs to the PleurEvac
9. Restart chest tube to suction -20
Anticipatory planning:
- STOP administering if patient has pleural hemorrhage (frank blood)
- Having some blood-tinged pleural fluid is common, if it continues to become more bloody, ask pulmonary consult team to assess
- When in doubt, OK to hold a treatment and talk to pulmonary consult team
#Chest #ChestTube #Tube #Thoracic #TPA #Dornase #Instructions #Administration
Dr. Gerald Diaz
@GeraldMD
· 3 weeks ago
