Streptokinase dose

1. Reconstitution of the Vial
Each vial contains 1.5 million units of streptokinase.

It’s reconstituted in 10 ml of normal saline → each 1 ml contains 150,000 units.

2. Dose for a 10 kg Child
Dose = 15,000 units/kg → for 10 kg = 150,000 units.

From the reconstituted vial, this equals:
150,000÷150,000=1ml.

3. How Much Should I Further Dilute the 1 ml For Intrapleural Use?
The volume depends on the size of the pleural cavity.

For pediatric patients, it’s common to dilute the dose in 10–50 ml of saline, depending on age and cavity capacity.

For a 10 kg child, dilution in around 10–20 ml of saline is reasonable.

4. Route of Administration
Direct instillation via the chest tube is acceptable; no need for an infusion pump.

After instillation, clamp the chest tube for 4 hours to allow the drug to act.

5. How Many Times Per Day and For How Many Days?
Most protocols recommend:

Once daily administration.

For up to 3 consecutive days, depending on the clinical and radiological response.

In rare cases, it’s given twice daily, but only under close monitoring.

6. How to Monitor Effectiveness?
Ideally with chest ultrasound (US) daily or every other day.

If ultrasound is unavailable:

Monitor the amount of fluid drained through the chest tube.

Also assess the patient’s clinical condition (e.g., fever, respiratory status).

7. When to Consider Removing the Chest Tube?
If the patient is clinically stable and:

The drainage has decreased to <20 ml per day, and

There are no signs of residual effusion or infection (based on clinical signs or imaging),

Then it's usually safe to remove the chest tube.

8. Should I Wait Until There's Zero Drainage?
Not necessarily.

If the drainage is minimal (e.g., <20 ml/24h), and the patient is stable with no signs of ongoing infection or fluid buildup, removal is typically appropriate.