How to give intrapleural tPA & Dornase:
There is evidence to support the administration of tPA+DNAse simultaneously. However, you should give it separately if the pulmonary team states otherwise.
- tPA will arrive at bedside (it is only usable ~30 mins after it arrives at bedside)
- Turn off suction on chest tube
- Turn the stopcock towards the PleurEvac (C) (the direction that the stopcock is pointing to = direction that it’s blocking).
- Administer the tPA (and Dornase), observing usual sterile technique (dosage may vary based on pulmonary team recommendations)
- Flush chest tube with 30cc sterile saline flush
- Turn the stopcock towards the patient (A) to trap the tPA and dornase in the patient’s pleura
- Wait 1 hour to allow the medication to work
- If you are asked to administer tPA & Dornase separately, you can repeat Steps 3-7 with Dornase.
- Turn the stop cock to the tPA port (B) & allow drainage from the lungs to the PleurEvac
- Restart chest tube to suction -20
- 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
Thanks to Dr. Duong for allowing me to build off his chest tube instructions