Alteplase for the treatment of midline catheter occlusions: a retrospective, single-cohort descriptive study

Br J Nurs. 2022 Jul 21;31(14):S6-S16. doi: 10.12968/bjon.2022.31.14.S6.


Background: Despite the increasing popularity of midline catheters, data on the use of alteplase for restoring midline catheter patency is scarce.

Aims: This study aimed to evaluate off-label use of alteplase for midline catheter occlusions.

Method: Adults who received alteplase into a midline catheter between January 2015 and May 2018 within a multi-hospital health system were included in this study. The primary outcome was restoration of infusion or withdrawal function from at least one lumen of a treated midline catheter.

Findings: Following alteplase administration, withdrawal function was restored in 47% (25/53) of occlusion events, infusion function was restored in 65% (11/17) of complete occlusion events, and infusion or withdrawal function was restored in 58% (31/53) of occlusion events. Only 34% (17/50) of catheters were replaced because of malfunction. Local bleeding was documented in 9% (n=5) of occlusion events after alteplase administration.

Conclusion: Most midline catheter occlusions treated with alteplase demonstrated restoration of infusion or withdrawal function.

Keywords: Alteplase; Complete catheter occlusion; Midline catheter; Occlusion; Partial catheter occlusion.

MeSH terms

  • Adult
  • Catheter Obstruction
  • Catheterization, Central Venous*
  • Fibrinolytic Agents / therapeutic use
  • Humans
  • Retrospective Studies
  • Tissue Plasminogen Activator / therapeutic use
  • Vascular Diseases*


  • Fibrinolytic Agents
  • Tissue Plasminogen Activator