Open AccessUnintentional intramuscular administration of tPA / DN ase for pleural infection
Author(s) -
Popowicz Natalia,
Nash Michael,
Lee Y. C. Gary
Publication year - 2014
Publication title -
respirology case reports
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 0.304
H-Index - 9
ISSN - 2051-3380
DOI - 10.1002/rcr2.80
Subject(s) - medicine , tissue plasminogen activator , parapneumonic effusion , pleural effusion , deoxyribonuclease , surgery , chest tube , thoracostomy , anesthesia , pleural fluid , enzyme , biochemistry , chemistry , pneumothorax
Intrapleural tissue plasminogen activator ( tPA ) and deoxyribonuclease ( DN ase) 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 / DN ase. Safety data of this regimen remain limited. Pleural contents often track along chest drains, but the effect of tPA / DN ase 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 DN ase (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 / DN ase administered with clearance of his loculated complicated parapneumonic effusion. This case adds to the safety profile of intrapleural tPA / DN ase therapy and highlights the importance of correct tube placement.