tPA

[Gabby-RN]

Does you hospital have documentation guidelines for tPA administration? What are you required to chart during infusion and how often? Does it differ based on the reason for administration-i.e. CVA versus PE?

If you are not required to chart specific things at specific times, what is your personal practice?

This question is most specifically for the ED but if you work on an inpatient unit feel free to answer as well.

[msjellybean]

This is tPA for CVA. We do use it PEs and DVTs, but I'm not sure what the standards are because we don't do that in the ED. All of that is started in IR and then sent to the ICU.

VS and neuro checks, q15 minutes during infusion and 1 hour post infusion. There's to be an MD documented NIHSS, two hours after administration. Then after infusion, we have VS & neuro checks q30 minutes for some period of time that I can't remember... maybe 4 hours? After that, I think we transition to VS & neuro checks q60 minutes x16 hours, I believe. I'm probably off a little bit - it's been a while since I've worked with tPA.

There's also another MD NIHSS at 23 hours post infusion.

[MunoRN, RN]

Sign of CVA=head CT, if no signs of bleed then an an initial NIH is done by the RN, tPA bolus is given followed by one hour infusion. NIH is done again 2 hours post tPA and again at 24 hours and then at discharge. q 1 hour neuros x24 hours, during which they must remain in ICU.

[Gabby-RN]

I wish tPA was only done in the ICU. So frequently there are not beds available and we have to do the entire process in the ED, regardless if it's for CVA or PE. Not the best scenario when it's busy and you have 3-5 other patients.

I wish tPA was only done in the ICU. So frequently there are not beds available and we have to do the entire process in the ED, regardless if it's for CVA or PE. Not the best scenario when it's busy and you have 3-5 other patients.

Any joint that has a nurse giving tPA while having 5 other patients should be thoroughly ashamed of themselves... totally inappropriate staffing.

[ChristineN, BSN, RN]

Any joint that has a nurse giving tPA while having 5 other patients should be thoroughly ashamed of themselves... totally inappropriate staffing.

Agreed. This would never happen where I work.

[turnforthenurse, MSN, NP]

I know tPA dosing is different for CVA than for MI, not sure about PE. Dosage is 0.9mg/kg. The first 10% is given as a bolus over 1 minute and the remaining 90% is given as an infusion over an hour. Prior to giving tPA, we need to have VS documented, have at least 2 patent IV sites (because you can't poke them with needles once you start! Same with any other tubes (NG, Foley)), have their NIHSS score already documented in the chart and baseline visual acuity. VS are done Q15min x2 hours and then Q30min x4-6 hours. Neuro checks are performed with each set of VS. The patient needs to be assessed for s/s bleeding (check IV sites, orifices and so forth.). I&O needs to be recorded. No anticoags/antiplatelets or NSAIDs for the first 24 hours.