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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

Chest X-ray after effective intrapleural delivery of tPA and DNase treatment and removal of ICC. The large left pleural opacity has largely resolved.
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fig02: Chest X-ray after effective intrapleural delivery of tPA and DNase treatment and removal of ICC. The large left pleural opacity has largely resolved.

Mentions: The patient was transferred to our pleural unit for further management. On arrival, an 18F chest tube was inserted into the left pleural effusion under ultrasound guidance. Only 200 mL drained spontaneously over 24 h and ultrasound confirmed a significant residual collection. Intrapleural tPA/DNase was recommenced the following day. Following two doses of tPA/DNase, 800 mL of pleural fluid was drained in 24 h, paralleled by resolution of the pleural opacities on CXR and normalization of leukocyte count and CRP in peripheral blood. The drain was removed two days later. The patient was followed up to two months with no residual symptoms or radiographic abnormalities (Fig. 2). The site of intramuscular tPA/DNase delivery healed spontaneously.


Unintentional intramuscular administration of tPA/DNase for pleural infection.

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

Chest X-ray after effective intrapleural delivery of tPA and DNase treatment and removal of ICC. The large left pleural opacity has largely resolved.
© Copyright Policy - open-access
Related In: Results  -  Collection

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

fig02: Chest X-ray after effective intrapleural delivery of tPA and DNase treatment and removal of ICC. The large left pleural opacity has largely resolved.
Mentions: The patient was transferred to our pleural unit for further management. On arrival, an 18F chest tube was inserted into the left pleural effusion under ultrasound guidance. Only 200 mL drained spontaneously over 24 h and ultrasound confirmed a significant residual collection. Intrapleural tPA/DNase was recommenced the following day. Following two doses of tPA/DNase, 800 mL of pleural fluid was drained in 24 h, paralleled by resolution of the pleural opacities on CXR and normalization of leukocyte count and CRP in peripheral blood. The drain was removed two days later. The patient was followed up to two months with no residual symptoms or radiographic abnormalities (Fig. 2). The site of intramuscular tPA/DNase delivery healed spontaneously.

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