Administration Protocol
- Verify the bolus dose, infusion dose and discard dose with the Stroke Neurologist
- Reconstitute the vial of t-PA with the supplied preservative-free water ...
- Hand the bolus dose syringe to the Stroke Neurologist and verify again the bolus dose, infusion dose and rate and discard dose
- Stroke Neurologist will administer bolus dose via intravenous push method over one minute ...
- Administer within 30 minutes of hospital arrival.
- Adults greater than or equal to 67 kg get 100 mg total dosage administered as a 15 mg IV bolus, followed by 50 mg IV infused over 30 minutes, and then 35 mg IV infused over the next 60 minutes.
How do you mix and administer tPA?
Hold the water vial firmly in the upright position. With your other hand hold the tPA upside down, and lower the vial down onto the spike. With both vials firmly spiked, invert both vials together. At this point, the water will on top and will flow from the water vial into the tPA vial.
How do you infuse alteplase?
Administer the IV bolus directly through the Y site injection port of the vented IV tubing or program the infusion pump to deliver the bolus dose. Immediately following the bolus dose, infuse the remaining 90% of the 0.9 milligrams per kilogram dose over 60 minutes.
How long does tPA take to infuse?
Administer initial IV bolus over 1 minute. Infuse the remaining 90% of the 0.9-mg/kg dose over 60 minutes.
What is a tPA infusion?
A tPA is a drug used to break up a blood clot and restore blood flow to the brain. A tPA can only be administered within a few hours after stroke symptoms appear, so it is extremely important to call 911 at the first sign of a stroke.
Can you mix alteplase with normal saline?
Conclusions: Alteplase diluted in normal saline solution at a concentration of 0.01 mg/mL is biochemically stable and active at ambient temperature for as long as 24 hours as assessed by in vitro clot lysis assays.
What is the infusion rate for tPA?
c) Infusion dose: mL (Maximum 81 mg/81 mL) Administer infusion over 60 minutes. Near completion, a 50 mL 0.9% NS bag should replace empty tPA vial to ensure total dose is infused over 60 minutes. FULL DOSE: 0.9 mg/kg Administer 10% as a bolus over one minute and the remaining 90% over 60 minutes by continuous infusion.
What is a bolus of tPA?
Intravenous tissue plasminogen activator (tPA) (0.9 mg/kg, maximum 90 mg) with a bolus of 10% of the total dose given within 1–2 mins is the standard therapy for patients receiving thrombolytic therapy. Low-dose (0.6 mg/kg) tPA is also approved for thrombolytic therapy for ischemic stroke patients.
Do you flush after alteplase?
If there is no blood return, an additional 2 mg alteplase is instilled into the port. After an additional 30 min, patency is once again assessed. If patency is restored, 5 mL of blood is aspirated to clear the port of alteplase. The port is then flushed with 10 mL of normal saline using a pulsing method.
How is tPA bolus calculated?
Calculate dose: (Enter Body weight in kg OR in lb)in Kg: Kg or.in lb: ( lb / 2.2 )Total TPA dose is: weight in kg x 0.9 mg/kg = Total dose mg.Give 10 percent as bolus (10% of total dose as bolus)Infuse remaining dose over 60 minutes.
What is tPA protocol?
Administer within 30 minutes of hospital arrival. Adults greater than or equal to 67 kg get 100 mg total dosage administered as a 15 mg IV bolus, followed by 50 mg IV infused over 30 minutes, and then 35 mg IV infused over the next 60 minutes.
How do you give a stroke to alteplase?
Acute Ischemic Stroke Administer Activase as soon as possible but within 3 hours after onset of symptoms. The recommended dose is 0.9 mg/kg (not to exceed 90 mg total dose), with 10% of the total dose administered as an initial intravenous bolus over 1 minute and the remainder infused over 60 minutes.
Why can you only give tPA within 3 hours?
Most of them are ineligible because they come to the hospital after the three-hour time window." The timing of treatment is important, because giving a strong blood thinner like tPA during a stroke can cause bleeding inside the brain.
How do you administer alteplase in stroke?
Alteplase is administered intravenously at a concentration of 1 mg/mL for the treatment of acute ischemic stroke, pulmonary embolism, and myocardial infarction. The reconstituted solution is stable for 8 hours at room temperature.
What do you reconstitute alteplase with?
Reconstitution should be carried out using the transfer device provided and by adding the contents of the 100‑mL vial of preservative free SWFI to the 100-mg vial of Activase powder. Reconstitute Activase immediately before administration, using aseptic technique at all times.
Can Cathflo be diluted with normal saline?
No interactions were found between Cathflo Activase and Normal Saline Flush.
Do you give heparin and alteplase together?
When given in conjunction with heparin, alteplase can improve the clinical course of stable patients who have acute submassive pulmonary embolism and can prevent clinical deterioration requiring the escalation of treatment during the hospital stay.
Equipment
1 vial of t-PA (alteplase, or Activase 100 mg) or two vials of t-PA (alteplase, or Activase 50 mg each)
Administration Protocol
It is appropriate to mix tPA prior to CT even if it is not used: See below procedure for returning tPA that is mixed but not administered.
Precautions and Side Effects
Hemorrhage (GI, GU, catheter puncture site, intracranial, retroperitoneal, pericardial, gingival, epistaxis)
Protocol for Returning Unused Medication at MGH
When tPA is mixed but not administered or the packaging is damaged, the reconstituted and unused tPA should be returned for pharmacy credit
Pregnancy & Lactation
Published studies and case reports on alteplase use in pregnant women are insufficient to inform a drug associated risk of adverse developmental outcomes; alteplase is embryocidal in rabbits when intravenously administered during organogenesis at clinical exposure for AMI, but no maternal or fetal toxicity was evident at lower exposure in pregnant rats or rabbits; the most common complication of thrombolytic therapy is bleeding; pregnancy may increase this risk; drug should be used during pregnancy only if potential benefit justifies potential risk to fetus.
Pharmacology
Recombinant human tissue-type plasminogen activator (t-PA); produces local fibrinolysis
Administration
Use only the accompanying sterile water for injection (without preservatives); do not use bacteriostatic water for injection
Formulary
Adding plans allows you to compare formulary status to other drugs in the same class.
How It Works
TPA is a naturally occurring protein found on endothelial cells, the cells that line blood vessels. It activates the conversion of plasminogen to plasmin, an enzyme responsible for the breakdown of clots, helping restore blood flow to the brain. 2 It is a powerful medication that must be administered by an experienced medical team.
Before tPA Treatment
Prior to receiving treatment with tPA, you should expect to have a brain computerized tomography (CT) scan. 3 This is because there are several medical conditions that make it too dangerous for you to receive tPA. If you have any of these conditions, not only would tPA not help you, it could cause significant harm to your health.
Administration of tPA
Treatment with tPA has been effective for people with an ischemic stroke as long as it is received intravenously within up to 4.5 hours of the onset of symptoms. 3 Endovascular treatment to remove the clot or deliver tPA at the site of the clot is considered for up to 24 hours after a stroke.
Side Effects
While tPA has been shown to be beneficial in the treatment of stroke, there is a risk associated with tPA treatment, even for people who have been medically cleared for tPA. It is a powerful blood thinner, and serious side effects may occur, including the following: 5
Recognizing Symptoms of a Stroke
The best way to maximize your chances of receiving the most effective treatment for a stroke is to get to the emergency room as soon as possible. A person who is having a stroke may not notice when they are experiencing symptoms. You can learn how to recognize a stroke so that you can get immediate help.
A Word From Verywell
Stroke prevention is a vital part of a healthy lifestyle. While treatments are becoming more effective for reducing the serious consequences of a stroke, prevention is the most effective way to avoid the consequences of stroke.
