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/clinical/references/stroke/thrombolysis/stroke-t-pa-protocol/

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Patient Care,

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Clinical Hub,References,Comprehensive Stroke Program,Thrombolysis

Stroke t-PA Protocol

Stroke t-PA Protocol - Clinical Hub, References, Comprehensive Stroke Program, Thrombolysis

Focus

Updated 10/3/2016

Administer Activase (t-PA) 0.9 mg/kg(max 90mg) IV, 10% as a bolus over 1 minute and the other 90% given over one hour by continuous infusion 

Temperature: every 2 hours 

B/P , pulse and respirations:

During infusion:  Every 15 minutes 

After infusion:  Every 15 minutes for the first two hours 

Then every 30 minutes for the next 6 hours

Then every hour for the duration of 24 hours post therapy. 

If SBP > 180mmHg or

Consider labetolol 10mg IV.  Repeat as necessary every 10-20 minutes

Consider labetolol 20mg IV for SBP >200 or MAP>120

If target BP is not reached:

Consider Nicardipine infusion (begins at 0.5mcg/min) 

Risk of ICH is especially high, particularly in the first 24 hours

For suspected ICH (neurological deterioration, new headache, acute hypertension, nausea/vomiting):

  1. Notify stroke neurologist STAT
  2. CT scan STAT 

No antiplatelet or anticoagulant medication for 24 hours and then only if required for management of associated medical problems in consultation with a member of the Stroke Team. 

Bleeding and bruising may occur, take care to avoid injury when moving patient. 

Avoid arterial, venous or lumbar punctures for at least one hour after tPA infusion has completed. 

Check all urine and stools for occult blood

Avoid NG insertion and bladder catheter insertion for the first 60 minutes after infusion completed.