The document appears to be a transcript of a Twitter chat between various medical professionals discussing topics related to intravenous (IV) therapy and central venous access devices (CVADs). Specifically, they discussed their experiences at recent infusion nursing conferences, new books on IV topics, and the use of tissue plasminogen activator (tPA) or alteplase to treat occluded CVADs when blood return cannot be obtained. Participants agreed that nurses should assess for other potential causes of occlusion before administering tPA to break up clots.

1. http://www.printyourtwitter.com/tweets.html
IVchat: Two hours till the #IVchat today...May 21 at 1100amET! Come join us!
5/21/2010 09:00
IVchat: One hour till #IVchat...hope you can join us at 1100am ET #IVchat
5/21/2010 10:08
IVchat: I'm searching for #IVchat live on TweetGrid Search - http://tweetgrid.com
/search?q=%23IVchat
5/21/2010 10:50
IVchat: @VascularAccess ..thanks, looking forward to meeting you on #IVchat
5/21/2010 10:55
VascularAccess: I'm Michelle, I insert PICCs and give infusions #IVchat. Nervous but excited to be her
5/21/2010 11:03
IVchat: Hi all! I'm Cora, infusion nurse and will be moderating the IV chat. Welcome! #IVchat
5/21/2010 11:04
ONSmark: Happy Friday all. I'm Mark, who has never done any type of IV insertion himself but oddly
enough is familiar with IV literature :) #ivchat
5/21/2010 11:05
IVchat: 1st topic coming up..please put T1 or T2 before ur replies..#IVchat
5/21/2010 11:08
IVchat: T1 - INS & ONS mtgs just finished. During exhibits hrs, did the lack of "tschotkes" affect ur
time w/ vendors/industry?#IVchat
5/21/2010 11:10
VascularAccess: T1 - went to INS not ONS but can say that maybe it did a little. Most r giving reference
books now - I like that better #IVchat
5/21/2010 11:12
InfusionNurse: @VascularAccess ..I agree, I rather have books then pens altho pens never influenced me
to use their product #IVchat
5/21/2010 11:14
IVchat: Next topic coming up... #IVchat
5/21/2010 11:18
ONSmark: T1 Sorry if it's slightly off topic, but let me know the titles of any good new books you
received at the conferences, thanks. #ivchat
5/21/2010 11:18
InfusionNurse: @ONSmark T1 - the one I got was an IV drug reference manual and one raffled off an IV
therapy textbook #IVchat
5/21/2010 11:20
VascularAccess: T1 - handbook on IV meds by Lippincott. Didn't win the textbook tho #IVchat
5/21/2010 11:21
ONSmark: Somebody was lucky if they were raffling the great 3rd ed. of the 600+ page INS Infusion
Nursing: an Evidence-Based Approach! #ivchat
5/21/2010 11:22
IVchat: T2 - thoughts on the frequent/immediate use of tPA for CVADs when unable to obtain a
blood return. #IVchat
5/21/2010 11:22
1 of 3 5/21/2010 4:06 PM

2. http://www.printyourtwitter.com/tweets.html
ONSmark: @VascularAccess Thanks for specifying a Lippincott handbook. #ivchat
5/21/2010 11:23
InfusionNurse: @ONSmark ..actually they did...some lucky infusion nurses got several! #IVchat
5/21/2010 11:23
VascularAccess: T1 - what I liked the best was the simulation labs esp the IO cadaver lab...#IVchat
5/21/2010 11:24
VascularAccess: T1 - FA Davis also released IV flash card and the INS president's new book..#IVchat
@ONSmark
5/21/2010 11:26
InfusionNurse: RT @IVchat: T2 - thoughts on the frequent/immediate use of tPA for CVADs when unable
to obtain a blood return. #IVchat
5/21/2010 11:26
InfusionNurse: T2 - tPA is very effective no doubt, my concern is immediate use w/o assessing why the
CVAD has no blood return, could b other probs #IVchat
5/21/2010 11:28
VascularAccess: T2 - u mean cathflo, right? #IVchat
5/21/2010 11:31
IVchat: Yes, that's the trade name..RT @VascularAccess: T2 - u mean cathflo, right? #IVchat
5/21/2010 11:32
ONSmark: Alteplase is Cathflo. #ivchat
5/21/2010 11:33
ONSmark: RT @ONSmark: T2 Alteplase is Cathflo (I added the "T2" this time!) #ivchat
5/21/2010 11:34
InfusionNurse: @ONSmark..T2 - any literature on possible excessive use that u know of? #IVchat
5/21/2010 11:34
ONSmark: @InfusionNurse T2 Good timing: I'm looking at a bunch of refs I had saved on
Alteplase/Cathflo right now and (cont.)... #ivchat
5/21/2010 11:35
VascularAccess: T2 - we use it a lot. Not sure if all nurses are only after making sure no other probs r
present. #IVchat
5/21/2010 11:37
ONSmark: T2 (cont.)...ones like "Alteplase for the Management of Occluded Central Venous Access
Devices: Safety Considerations" don't address #ivchat
5/21/2010 11:37
ONSmark: @InfusionNurse T2 You said excessive *use*: http://bit.ly/at8w1N states "Excessive
pressure should be avoided when alteplase is..." #ivchat
5/21/2010 11:39
InfusionNurse: @VascularAccess ..it is important to assess 1st before using it but in reality, most r using
it right away cuz its available #IVchat
5/21/2010 11:40
InfusionNurse: @ONSmark T2 - excessive - meaning using a lot w/o even assessing cause of lack of
blood return. #IVchat
5/21/2010 11:43
2 of 3 5/21/2010 4:06 PM

3. http://www.printyourtwitter.com/tweets.html
InfusionNurse: T2 @ONSmark..some CVAD def need it, while others may not but still get cathflo..#IVchat
5/21/2010 11:45
ONSmark: T2 2008 article @ http://bit.ly/al2qCI has info like "If blood return is not obtained after 30
min of dwell time, alteplase should.. #ivchat
5/21/2010 11:46
IVchat: We only have 2 topics today..15 minutes left... #IVchat
5/21/2010 11:48
VascularAccess: T2 @infusionnurse...I agree..nurses need need to take the time to assess 1st for other
causes b4 cathflo. #IVchat
5/21/2010 11:50
ONSmark: @IVchat I just realized we overlapped with #RNchat today! So many chats, not enough
time :) #ivchat
5/21/2010 11:50
InfusionNurse: @ONSmark ..T2 that's if ur already using. I think b4 using, need to r/o other causes b4
instilling alteplase. #IVchat
5/21/2010 11:52
IVchat: ik, will not do that again.RT @ONSmark: @IVchat I just realized we overlapped with
#RNchat today! So many chats, not enough time :) #IVchat
5/21/2010 11:53
InfusionNurse: @ONSmark ..thanks for joining us, I know #RNchat is going on 2.. will try not to overlap
again next time w/ #RNchat #IVchat
5/21/2010 11:55
ONSmark: @InfusionNurse T2 Thanks, now I get it, determine other causes even before instillation.
#ivchat
5/21/2010 11:55
IVchat: Out of respect for #RNchat, we will wrap up our #IVchat today. Thanks everyone for
joining. Next #IVchat June 1 at 1200 ET. #IVchat
5/21/2010 11:56
rnchat: @IVchat Oh dear!! I had no idea!! No, we wont compete for times again!! Yikes~ Its also
#ivchat #RNchat
5/21/2010 11:57
ONSmark: Thanks all! And please forgive my "plug" but the new ed. of the #ONS Access Device
Guidelines is supposed to publish late fall 2010 #ivchat
5/21/2010 11:58
IVchat: @vascularaccess @ONSmark and all others lurking..thanks! See u next time. Please join
#RNChat now in progress.. #IVchat
5/21/2010 11:59
InfusionNurse: @ONSmark ..Yippee..been waiting for that..happy to disclose I was privileged to have
reviewed the draft. #IVchat
5/21/2010 12:01
3 of 3 5/21/2010 4:06 PM