Intrapleural Fibrinolytic Instillation

Indications

Complicated Parapneumonic Effusion/Empyema (see Pleural Effusion-Parapneumonic)

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