Transcript Administering Thrombolysis Early Management

Administering Thrombolysis
Early Management
Angela Roots
Stroke Practice Facilitator
[email protected]
What have we learnt so far?
What we have learnt so far...
Why thrombolyse
 Inclusion/exclusion

◦ Family
◦ Medical history/pre-morbid state
◦ LAS
decision making
 Assessment (NIHSS)
 Scans
 Time

On arrival
LAS phone ahead
 Bleep system activated
 Stroke team waiting in ED
 History from LAS & family
 Admit patient, portable monitoring, CT
Scan

What next?
Consent
 IV access
 Observations
 Pre-empting risk
 Dose
 Administration
 Communication

Consent
Up to 4.5 hours
 Post 4.5 hours
 Pt aphasic / confused / mental health
problems
 Family disagrees
 What would you do??

IV access
2 cannulas
 Minimise and monitor puncture sites
 Ask for assistance after 3 failed attempts

Observations
hypertensive
If DBP>110mmHg or SBP >180 mmHg:
 IV labetalol 10 -20 mg over 1 minute, repeated
after 10 minutes till response
Max. total dose 300 mg/24 hours (HR>60bpm)


IV GTN (0.5-10mg/hour) and use same target
parameters

What is your local policy?
Observations
hypertensive
Higher risk of bleed
 Avoid rapid drop in blood pressure
 Monitor heart rate
 Headache

Observations

Blood Sugar levels
◦ ?cause of neurological deficit

INR
◦ Main laboratory
◦ CoaguCheck
Plan ahead, what are the risks?

Bleeding
◦
◦
◦
◦
Puncture sites
Wounds
GI
Cathlabs
Deterioration
 Anaphylaxis
 Overnight cover
 Staffing skill mix
 Ceiling of care

Dose

0.9mg/kg

Weight required


Estimated vs actual
90mg maximum dose
Estimate the weight
52kg
89.6kg
Dose and administration
10% total dose given as a bolus over 2 minutes then remainder via
infusion pump over 1 hour
Dose and administration



Keep dose calculation chart
handy
Ensure clear prescription of
total dose or bolus then
infusion to avoid confusion
once bolus administered
Avoid double concentration
1mg/1ml
Dose and administration
Often need more than 1 vial of drug so 2
syringes to be completed
 Monitor for extravasation carefully
 Keep check on infusion pump rate during
the hour
 Ensure the infusion tubing is flushed
slowly at completion to ensure the 2ml in
the infusion tubing is administered

Dose and administration

Before you give the drug;
◦ Stop, stand back, reassess
◦ Signs of improvement?
Location
ED Resus area
 Bolus in CT scanning department (fully
monitored)
 HASU ? What do you think?

Communication
Patient, family, carers
 Ward

◦ Staffing capacity
◦ Skill mix
◦ Cardiac monitored bed

Bed manager/ site nurse practitioner
So do you think
we should
thrombolyse?
Yes! Lets
go, time is
brain!!!