Maintaining and restoring the function of central venous access devices (CVAD) is an important component of pediatric oncology nursing care. Until 1999, Abbokinase Open Cath (urokinase; Abbott, Abbott Park, IL), a thrombolytic agent was the product primarily used to resolve thrombotic occlusions in intravascular devices. Changes in the manufacturing process mandated by the FDA have resulted in a lack of availability of Abbokinase Open Cath. Recombinant tissue plasminogen activator (TPA) has provided an alternative solution for clearing occluded intravascular devices. This article reviews the literature supporting the use of TPA for CVAD clearance and discusses the process of how to administer the medication. Future implications for research about the use of TPA, and its role in the care of CVADs are discussed.