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ED/IP - STEMI Thrombolytic Therapy - Adult - Supplemental [6081]

ED/IP - STEMI Thrombolytic Therapy - Adult - Supplemental [6081] - Clinical Hub, UW Health Clinical Tool Search, UW Health Clinical Tool Search, Order Sets, Inpatient, Cardiology/CT Surgery


ED/IP - STEMI Thrombolytic Therapy - Adult - Supplemental [6081]
This order set may ONLY be used if ALL of the following criteria are met:
1) ECG meets ACC/AHA STEMI criteria within 12 hours of symptom onset in an awake patient
2) Timely Percutaneous Coronary Intervention (PCI) cannot be achieved. (Goal is less than 90
min from first medical contact)
indication to thrombolytic-3) No clinical signs or symptoms of cardiogenic shock or other contra
therapy (see below)
4) Discussion with the UW Interventional Cardiologist to confirm that thrombolytic therapy is the
best course of action
Absolute Contraindications to Thrombolytic Therapy
Prior hemorrhagic CVA•
Any cerebrovascular events < 1 Year•
Active bleeding•
• Known intracranial neoplasm
• Suspected aortic dissection
Relative Contraindications to Thrombolytic Therapy
• Blood Pressure >180/110mmHg
• Use of anticoagulants
compressible vascular punctures-Non•
Prolonged CPR >10 minutes•
Prior gastrointestinal hemorrhage•
Pregnancy•
Recent Trauma•
Recent Surgery•
Patient Care Orders
Vital Signs [208157]
Vital Signs [NURMON0013] SEE COMMENTS, Routine
Temperature Measurement Method:
Temperature Measurement Restrictions:
BP Source:
BP Location:
BP Position:
BP Restrictions:
Starting with Alteplase infusion: Every 15 minutes for
two hours, every 30 minutes for two hours, then every
hour for three hours.
Assess Neurologic Status Using UWHC
Abbreviated NIHSS Flow Sheet [NURMON0006]
SEE COMMENTS, Routine, Starting with Alteplase
infusion: Every 15 minutes for two hours, every 30
minutes for two hours, then every hour for three
hours.
Patient Monitoring [208158]
Cardiac Rhythm Monitoring - Adult
[NURMON0010]
CONTINUOUS, Starting today, Routine
Notify Provider: Symptomatic Change in
Rhythm,Serious Arrhythmia
Functional Cardiac Defibrillator Present:
Activity [208159]
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Copyright © 201� University of Wisconsin Hospitals and Clinics Authority
Contact: Lee Vermeulen, CCKM@uwhealth.org Last Revised: 09/2016CCKM@uwhealth.org

Activity - Bedrest [NURACT0008] CONTINUOUS, Starting today, Routine
AD LIB:
AMBULATE:
CHAIR:
DANGLE:
BEDREST: other (comment)
RESTRICTIONS:
UPPER LEFT EXTREMITY WEIGHT BEARING:
UPPER RIGHT EXTREMITY WEIGHT BEARING:
LOWER LEFT EXTREMITY WEIGHT BEARING:
LOWER RIGHT EXTREMITY WEIGHT BEARING:
Bed rest during Alteplase administration and for 12
hours post alteplase completion.
Contingency Parameters [208160]
Notify Provider [NURCOM0001] Provider to Notify: Provider
If systolic blood pressure > (mmHg): 180
If systolic blood pressure < (mmHg): 90
If diastolic blood pressure > (mmHg):
If diastolic blood pressure < (mmHg):
If temperature > (C): 38
If temperature < (C):
If heart rate > (bpm):
If heart rate < (bpm):
If respiratory rate >:
If respiratory rate <:
If blood glucose > (mg/dL):
If blood glucose < (mg/dL):
If pain score >:
Pulse Oximetry < (%):
If urine output < (mL):
Other: Any change in neurologic status
Intravenous Therapy
IV Fluids [208161]
Insert and Maintain Peripheral IV [NURVAD0013] CONTINUOUS, Starting today, Routine
Peripheral IV Size: RN Discretion
Does this need to be inserted/placed? Yes
Insert and maintain 2 total peripheral IVs. Check and
document patency, tubing change, site assessment,
and dressing change per policy.
Medications
Thrombolytics/Anticoagulation Therapy [208195]
Supplemental [4373] to order the –Adult –Heparin Anticoagulation –Use order set IP/ED
Coronary Syndrome (WITHOUT IIb/IIIa Acute “heparin bolus and infusion. Select the regimen,
inhibitor).” DO NOT duplicate heparin initial bolus order if already ordered via the STEMI order
set.
and infusion the Alteplase bolus first. May run alteplase infusion and heparin bolus Administer
simultaneously
Thrombolytics [208380] "And" Linked Panel
alteplase (ACTIVASE) vial kit 15 mg (BOLUS)
[785066]
15 mg, Intravenous, ONCE For 1 Doses
Pharmacist to prepare 100 mg of alteplase in 100
mL bottle or bag. RN to administer all doses of
alteplase from the same 100 mL bottle/bag.
Alteplase order 1 of 3. Follow immediately with
alteplase order 2. Administer over 1 minute.
Page 2 of 3
Printed by LIND, JANNA S [JSL237] at 9/8/2016 2:37:00 PM
Copyright © 201� University of Wisconsin Hospitals and Clinics Authority
Contact: Lee Vermeulen, CCKM@uwhealth.org Last Revised: 09/2016CCKM@uwhealth.org

alteplase (ACTIVASE) 50 mg in water (sterile)
100 mg bag [700131]
50 mg, Intravenous, ONCE For 1 Doses
Pharmacist to prepare 100 mg of alteplase in 100
mL bottle or bag. RN to administer all doses of
alteplase from the original 100 mL bottle/bag.
Alteplase order 2 of 3. Follow immediately with
alteplase order 3. Administer over 30 minutes.
**IV Alteplase infusions must be infused until the
drip is completed even if reperfusion is noted.
alteplase (ACTIVASE) in water (sterile) 100 mL
bag [700131]
35 mg, Intravenous, ONCE For 1 Doses
Pharmacist to prepare 100 mg of alteplase in 100
mL bottle or bag. RN to administer all doses of
alteplase from the original 100 mL bottle/bag.
Alteplase order 3 of 3. Administer over 60 minutes.
**IV Alteplase infusions must be infused until the
drip is completed even if reperfusion is noted
sodium chloride 0.9% BOLUS [730003] 50 mL, Intravenous, ONCE For 1 Doses
Near end of the infusion as the infusing alteplase
bottle/bag is nearly empty, replace the empty
alteplase bottle/bag with the sodium chloride 0.9%
50 mL bag to ensure the total alteplase dose is
infused over the programmed 90 minute infusion.
NOTE: If there is an interruption in administration
of Alteplase or heparin infusions due to a change
in clinical status, notify the interventional
cardiologist immediately. [950018]
4 X DAILY (NOTE ACKNOWLEDGE)
NOTE: If there is an interruption in administration of
Alteplase or heparin infusions due to a change in
clinical status, notify the interventional cardiologist
immediately.
Diagnostic Tests and Imaging
Diagnositic Tests and Imaging [208230]
ECG - 12 Lead [EKG0008] ONCE For 1 Occurrences, Routine
Reason for exam: ACUTE ST ELEVATION MI
Perform ECG every 30 minutes times 3.
ECG - 12 Lead [EKG0008] ONCE For 1 Occurrences, Routine
Reason for exam: ACUTE ST ELEVATION MI
Perform ECG every 30 minutes times 3.
ECG - 12 Lead [EKG0008] ONCE For 1 Occurrences, Routine
Reason for exam: ACUTE ST ELEVATION MI
Perform ECG every 30 minutes times 3.
Page 3 of 3
Printed by LIND, JANNA S [JSL237] at 9/8/2016 2:37:00 PM
Copyright © 201� University of Wisconsin Hospitals and Clinics Authority
Contact: Lee Vermeulen, CCKM@uwhealth.org Last Revised: 09/2016CCKM@uwhealth.org