What pharmacologic agents can be injected into septated or viscous abdominal fluid collections to improve drainage?
Intracavitary fibrinolysis therapy with tissue plasminogen activator (tPA) can be performed through the drainage catheters to shorten treatment time and improve the clinical course of patients treated with percutaneous drainage catheters. Optimal dosing regimens have not been determined. Typical doses of tPA range from 2 to 6 mg of tPA diluted in 10 to 50 mL saline. The total volume of fluid depends on the size of the cavity. The dose is injected into the catheter, which is clamped for 1 to 2 hours after the dose is administered. After unclamping, the dose is allowed to drain spontaneously. The dose can be administered 1 to 3 times daily. Total number of doses varies depending on output response. Caution should be used with hepatic abscesses or in patients who are coagulopathic because of the potential increased risk of bleeding.