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



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