PLACE LABEL HERE
TISSUE PLASMINOGEN ACTIVATOR (TPA, ACTIVASE)
and
PULMOZYME (dornase alpha)
INTAPLEURAL FOR LOCULATED EMPYEMA
PROTOCOL
The following orders will be implemented per physician order of this protocol.
Orders with a “” are indicator choices and are NOT implemented unless checked.
Initial the bottom of each page when indicated (multipage).
This protocol may only be used in ICU or IMCU/PCU
1.
Tisue Plasminogen Activator (TPA, Activase) 10 mg
and
Pulmozyme (Dornase alpha) 5 mg
Administer intrapleurally BID x 3 days.
(Medications to be dispensed in separate irrigation syringes from pharmacy at time of
administration)
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2.
Administer Activase (TPA) 10 mg diluted in 30 ml NS intrapleurally via chest tube
Clamp chest tube for 1 hour.
Release clamp and allow to drain x 1 hour
Then administer Pulmozyme (dornase) 5 mg diluted in 30 ml sterile water intrapleurally via chest tube
Clamp chest tube for 1 hour
Release clamp and allow to drain.
Repeat every 12 hours for a total of 3 days (6 doses each)
Nursing Administration Technique for Intrapleural Administration
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Supplies must be ready: Kelly clamp, catheter plug, medication in catheter tip syringe
Use a Kelly clamp to clamp off the chest tube, not pleuravac tubing
Disconnect the chest tube from pleuravac tubing (helper holds the pleuravac tubing and places a
catheter plug on the end of the pleuravac tubing-or have a helper hold it and keep it sterile)
Connect the syringe with the medication to the chest tube, insert syringe until it fits snuggly into
place
Unclamp the chest tube, instill the medication
Use a Kelly clamp to clamp off the chest tube, not pleuravac tubing
Reconnect the chest tube to the pleuravac tubing but do not unclamp until the ordered dwell time is
complete
Unclamp the chest tube
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Date
___________________
Time
*1-37138*
FORM 1-37138
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Physician Signature
INITIATED 07/2014
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PID Number
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