You were asking for an Activase protocol? Here is ours:
1. Admit to ICU for thrombolytic therapy
2. Fill out "Screening Form for Thrombolytic Therapy" and notify MD of any contraindications.
3. 3 saline locks
4. I&O Q6hr
5. Complete bedrest with commode priveliges
6. Vitals Q15min until stable, Q1hr X6, then Q4hr
7. Apical pulse Q1hr per monitor
8. Weight on admit and daily
9. O2 @ 2-4L/min per NC PRN ox reading <90%
10. Clear liq diet advance to regular as tolerated
11. EKG on completion of TPA infusion, EKG when pt is pain free, and EKG in AM
12 UA, PT, PTT, CBC, and lytes
PRIOR TO TPA ADMINISTRATION
1 4baby ASA on admission
2. Beta Blocker ____yes _____no
a.atenolol/tenormin: 5mg IV, repeat in 10min if tolerated for a total of 10mg. Then 50mg po 10min after last IV dose and repeat Q12hr. D/C if bradycardia or hypotension requiring treatment occures. Reduce dose in half if patient already taking beta blocker,renal impairment with serum creat >q.3m/dl
< OR >
b.metoprolol/lopressor: 5mgIV repeat 5mg Q 5 min for total of 15mg. then 50mg po Q6hr for 48hr beginning 15min after last IV dose. follow with po maintenance dose of 100mg BID. Pt. who do not tolerate full IV dose start 25-50mg po 15 min after last IV dose.
3. Nitroglycerin infusion per protocol to control pain and maintain B/P @ 105-120 systolic ____yes _____no
4. Lidocain per protocol ____yes ____no
5. Foley catheter ____yes ______no
ADNINISTRATION of TPA:
1. Heparin 5,000u IV bolus before TPA
2. Administer TPA as follows:
a. Give 15mg IV push via syringe over 1-2min
b. Admin. remaining TPA @ 0.75mg/kg ove the first 30 min -DO NOT EXCEED 50mg
Give IV infusion of TPA @ 0.50mg/kg over the next 60 min.DO NOT EXCEED 35mg.
c. Total dose of TPA (bolus & infusion) NOT TO EXCEED 100mg
d. Follow infusion with a normal saline infusion @ the same rate to flush all TPA through tubing.
3. Heparin 1200u/hr IV infusion (start during the last hr of TPA adm.
4. PTT 6 hrs after heparin infusion initiated (maintain PTT at 60sec)
5. Observe for s/s reperfusion.
6. ASA 325mg po daily strating next am
7. Zantac 150mg po BID, if NPO then 50 mg IV Q8hr.
I'm not the best typist but hope this helps.
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