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Alteplase (rt-PA - Activase®) Reconstitution for UWHC Stroke Pharmacist

Alteplase (rt-PA - Activase®) Reconstitution for UWHC Stroke Pharmacist - Clinical Hub, References, Comprehensive Stroke Program, Thrombolysis

Focus

Updated 10/3/2016

“Stroke Pharmacist” group page #0309

(Group page #0309 includes pharmacists and their corresponding pagers as listed below, with only the designated pharmacist responding to the “Code Stroke.”) 

STROKE PHARMACIST GROUP PAGE #0309

24/7/365 coverage Emergency Medicine Pharmacist


Acute Ischemic Stroke

THE TOTAL DOSE FOR TREATMENT OF ACUTE ISCHEMIC STROKE SHOULD NOT EXCEED 90 mg. (NOTE: Vial contains 100 mg/100 mL) 

The recommended dose is 0.9 mg/kg (not to exceed 90 mg total dose) infused over 60 minutes with 10% {(0.09 mg/kg (max 9 mg)} of the total dose administered as an initial intravenous bolus over 1 minute via the smart pump. Reconstitution should be carried out using the transfer device provided, adding the contents of the accompanying 100 mL vial of Sterile Water, to the contents of the 100 mg vial of alteplase powder. Slight foaming upon reconstitution is not unusual; standing undisturbed for several minutes is usually sufficient to allow dissipation of any large bubbles. 100 mg VIALS DO NOT CONTAIN VACUUM.

  1. Use aseptic technique throughout.
  2. Remove the protective flip-caps from the vial of alteplase and Sterile Water (SW).
  3. Open the package containing the transfer device.
  4. Remove the protective cap from one end of the transfer device and keeping the vial of SW upright, insert the piercing pin vertically into the center of the stopper of the vial of SW first.
  5. Remove the protective cap from the other end of the transfer device. DO NOT INVERT THE VIAL OF SW.
  6. Holding the vial of alteplase upside-down, position it so that the center of the stopper is directly over the exposed piercing pin of the transfer device.
  7. Push the vial of alteplase down so that the piercing pin is inserted through the center of the alteplase vial stopper.
  8. Invert the two vials so that the vial of alteplase is on the bottom (upright) and the vial of SW is upside-down, allowing the SW to flow down through the transfer device (approximately 0.5 mL of SW will remain in the diluent vial). Approximately 2 minutes are required for this procedure.
  9. Remove the transfer device and the empty SW vial from the alteplase vial.
  10. Swirl gently to dissolve the alteplase powder. DO NOT SHAKE.
  11. After reconstitution remove the “Volume to be infused”{includes bolus dose (0.09 mg/kg (max 9 mg) plus the infusion dose (0.81 mg/kg (max 81 mg)} from the vial using syringe(s) provided.
  12. Place this “Volume to be infused” in an empty sterile bag and label the bag appropriately (example: alteplase 68 mg/68 mL).
  13. The provider administering the drug should program the smart pump to administer the bolus dose over 1 minute, and the infusion dose to be infused over 60 minutes.

*Near the end of the infusion a 50 mL mini-bag of normal saline should be connected to the tubing infusing the alteplase to ensure the residual medication in the tubing is infused accordingly in the 60 minute period. 

No other medication should be added to infusion solutions containing alteplase. 

If alteplase is taken out of the AcuDose and not used, please return the drug to the AcuDose. This will credit the charge to the patient.