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Unintentional intramuscular administration of tPA/DNase for pleural infection.

Popowicz N, Nash M, Lee YC - Respirol Case Rep (2014)

Bottom Line: Pleural contents often track along chest drains, but the effect of tPA/DNase on subcutaneous tissues is unknown.No complications were detected over a 2-month follow-up.This case adds to the safety profile of intrapleural tPA/DNase therapy and highlights the importance of correct tube placement.

View Article: PubMed Central - PubMed

Affiliation: Pharmacy Department, Sir Charles Gairdner Hospital Perth, Australia.

ABSTRACT
Intrapleural tissue plasminogen activator (tPA) and deoxyribonuclease (DNase) therapy has recently been shown to improve outcomes in pleural infection in a randomized trial. Published literature, to date, consists of only ∼50 patients who had received tPA/DNase. Safety data of this regimen remain limited. Pleural contents often track along chest drains, but the effect of tPA/DNase on subcutaneous tissues is unknown. We report a patient treated in another center who was unintentionally administered up to six instillations of tPA (10 mg) and DNase (5 mg) intramuscularly via a malpositioned chest drain. The patient experienced minimal discomfort, and there were no signs of tissue inflammation or necrosis on computed tomography. No complications were detected over a 2-month follow-up. Upon transfer, a new pleural drain was inserted and tPA/DNase administered with clearance of his loculated complicated parapneumonic effusion. This case adds to the safety profile of intrapleural tPA/DNase therapy and highlights the importance of correct tube placement.

No MeSH data available.


Related in: MedlinePlus

Coronal computed tomography chest slice showing (a) the intercostal catheter reflected away from the chest with the tip resting 30 mm from the pleural cavity; (b) a locule of pleural effusion; and (c) the raised left hemidiaphragm.
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fig01: Coronal computed tomography chest slice showing (a) the intercostal catheter reflected away from the chest with the tip resting 30 mm from the pleural cavity; (b) a locule of pleural effusion; and (c) the raised left hemidiaphragm.

Mentions: A subsequent computed tomography (CT) scan performed 18 h following completion of tPA/DNase therapy showed the distal end of the ICC was not positioned in the pleural cavity but approximately 30 mm outside it (Fig. 1). The tip of the ICC terminated in a fat plane between the Latissimus dorsi and Teres major, level with the inferior angle of the scapula. Some soft tissue swelling was seen around the distal end of the ICC, presumably because of residual fluid. Although it is possible that drain migration occurred during the course of tPA/DNase instillation, these images together with the lack of fluid drainage (after administration of fibrinolytics) strongly suggested that the majority of tPA/DNase doses were delivered not intrapleurally, but into the subcutaneous tissue/muscles. There were however no evidence of inflammation, necrosis, or other significant complications on CT. Throughout the course of treatment, the patient was relatively asymptomatic, and only experienced some mild local pain from the tPA/DNase instillations.


Unintentional intramuscular administration of tPA/DNase for pleural infection.

Popowicz N, Nash M, Lee YC - Respirol Case Rep (2014)

Coronal computed tomography chest slice showing (a) the intercostal catheter reflected away from the chest with the tip resting 30 mm from the pleural cavity; (b) a locule of pleural effusion; and (c) the raised left hemidiaphragm.
© Copyright Policy - open-access
Related In: Results  -  Collection

License
Show All Figures
getmorefigures.php?uid=PMC4263497&req=5

fig01: Coronal computed tomography chest slice showing (a) the intercostal catheter reflected away from the chest with the tip resting 30 mm from the pleural cavity; (b) a locule of pleural effusion; and (c) the raised left hemidiaphragm.
Mentions: A subsequent computed tomography (CT) scan performed 18 h following completion of tPA/DNase therapy showed the distal end of the ICC was not positioned in the pleural cavity but approximately 30 mm outside it (Fig. 1). The tip of the ICC terminated in a fat plane between the Latissimus dorsi and Teres major, level with the inferior angle of the scapula. Some soft tissue swelling was seen around the distal end of the ICC, presumably because of residual fluid. Although it is possible that drain migration occurred during the course of tPA/DNase instillation, these images together with the lack of fluid drainage (after administration of fibrinolytics) strongly suggested that the majority of tPA/DNase doses were delivered not intrapleurally, but into the subcutaneous tissue/muscles. There were however no evidence of inflammation, necrosis, or other significant complications on CT. Throughout the course of treatment, the patient was relatively asymptomatic, and only experienced some mild local pain from the tPA/DNase instillations.

Bottom Line: Pleural contents often track along chest drains, but the effect of tPA/DNase on subcutaneous tissues is unknown.No complications were detected over a 2-month follow-up.This case adds to the safety profile of intrapleural tPA/DNase therapy and highlights the importance of correct tube placement.

View Article: PubMed Central - PubMed

Affiliation: Pharmacy Department, Sir Charles Gairdner Hospital Perth, Australia.

ABSTRACT
Intrapleural tissue plasminogen activator (tPA) and deoxyribonuclease (DNase) therapy has recently been shown to improve outcomes in pleural infection in a randomized trial. Published literature, to date, consists of only ∼50 patients who had received tPA/DNase. Safety data of this regimen remain limited. Pleural contents often track along chest drains, but the effect of tPA/DNase on subcutaneous tissues is unknown. We report a patient treated in another center who was unintentionally administered up to six instillations of tPA (10 mg) and DNase (5 mg) intramuscularly via a malpositioned chest drain. The patient experienced minimal discomfort, and there were no signs of tissue inflammation or necrosis on computed tomography. No complications were detected over a 2-month follow-up. Upon transfer, a new pleural drain was inserted and tPA/DNase administered with clearance of his loculated complicated parapneumonic effusion. This case adds to the safety profile of intrapleural tPA/DNase therapy and highlights the importance of correct tube placement.

No MeSH data available.


Related in: MedlinePlus