Alteplase: Program savings

This guest post was written by Kim Norman, BA (hons) Nursing who is the Clinical Nurse Educator for ARHCC and ACDU Hemodialysis Units in the Fraser Health Renal program.

It became quite frustrating to watch, as a Clinical Nurse Educator, the use of alteplase within our Renal Program at a cost of $64 a vial.

After identifying a $100,000 expenditure on alteplase use within the hospital hemodialysis units  it was time to ask why, what could be done to reduce costs and how? This needed to be done while keeping in mind the best interests of the patients in relation to best practices.

After  identifying a huge cost to our Renal program what was also highlighted in the review process was a large cost in sterile supplies.  Alteplase and sterile supplies added up to $716,000 being spent each year in the FHA hemodialysis units.

After collaborating with the community dialysis staff, educators across Canada and within my own province of BC, we identified products that could potentially cut the cost of alteplase by reducing the exposure of the hub of a catheter to air (theory, not evidence based) by using a needle-less hemodialysis cap designed to withstand the blood pump speeds of dialysis.

The needless cap would also potentially reduce the costs of our sterile supplies due to the cap only needing to be changed every 7 days.

Once the product had been approved by the leadership team, the educators made all efforts (through education) to implement the device along with streamlining our hemodialysis access and flushing techniques. The implementation did not go without its barriers which are highlighted in the education powerpoint; such barriers are still being addressed between the educators and the company who distributes the device.

We are now one year post implementation and have seen a significant reduction in total costs.  Specifically, we’re seeing approximately $112K reduction in sterile supply costs and $23K reduction in tPA costs per year.

In fast paced hemodialysis units, we have received reports that this new intervention allows for more efficient use of time at the bed side.

The cost savings documents and education tool are attached for review.

Cost analysis:

Renal Tray costs for ARHCC

Tego Connectors FHA Cost Analysis

TPA Monitoring Tego

Educational Information:

TEGO patient pamphlet

Tego Poster Fraser Health


Kim Norman

Clinical Nurse Educator

Fraser Health Renal Program.


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