Announcements: Neuromuscular section updated with more questions.

  •  IV tPA Administration 
  • Review all exclusion criteria and confirm patient is eligible
  • Review benefits and risks with the patient and family and provide IV tPA information sheet
  • Obtain informed consent
  • Ensure 2 peripheral IV lines or more access
  • Call the pharmacy with patient information and instructions to mix and immediately deliver drug to patient location
  • Make sure pump available to deliver drug
  • Dose: 0.9 mg/kg body weight (maximum 90 mg)
  • 10% of dose given as a bolus – over one minute
  • Remainder of dose to be infused over 60 minutes (via pump)
  • When infusion is complete, attach a NS bag to tPA IV tubing & deliver remaining drug in tubing to administer full dose
  • Management of Anaphylaxis 
  • If stridor, oropharyngeal swelling, urticaria develop, immediately discontinue tPA infusion.
  • Administer IV methylprednisolone 125 mg, IV diphenhydramine 50 mg, IV famotidine 20 mg,
  • Consider early elective intubation if significant stridor or oropharyngeal swelling.
  • Early ENT notification if cricothyrotomy may be needed
  • Consider medicine consultation if no improvement
  • Consider CT scan to exclude retropharyngeal hematoma if suspected
  •  Post IV tPA Administration 
  • Admit to NICU 
  • NPO until patient is screened for dysphagia                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                            
  • Continue cardiac monitoring
  • Neurochecks q 15 mins x 2 hours, then q 30 mins x 6 hours, then q 1 hour x 16 hours
  • Rotate blood pressure cuff to avoid excessive bruising
  • No anticoagulants or antiplatelet agents for 24 hours
  • DVT prophylaxis
  • Repeat head CT, labs, U/A and guaiac stools at 24 hours post infusion

 from YNHH Stroke Service Policy “Administration of IV t-PA for Acute Ischemic Stroke

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