[LauraRN22]

Hi! I'm a new grad in the SICU and i had my first retavase pt today. I understand what retavase is and what it does, but i got VERY easily confused by the arterial sheath, arterial catheter, and arterial wire. What is the point of having all three things? Why cant there just be a catheter or something?!?!?! I cant even remember what the heck was going on with the retavase and my shift just ended 4 hrs ago!!! I was too preoccupied with the fact that my pt was squirming in the bed in terrible pain and I couldn't get DP or PT pulses in my affected foot-even with doppler. He's probably in OR right now! Anyways, I had 3 different retavase infusions going on and different rates for the sheath, catheter, wire- i think i had 2 different sheaths going in 2 different directions . HELP!!!!!!

[Zee_RN]

http://ccn.aacnjournals.org/cgi/content/long/22/3/57

"Reteplase infusions are given at a rate of 0.5 to 2 U/h, for a mean duration of 21 hours.13 The infusion is given via a catheter that is inserted in the extremity opposite the thrombus during angiographic studies. This technique is called catheter-directed thrombolytic therapy. The catheter is threaded through the opposite extremity to the affected extremity (eg, if the thrombus is in the right popliteal artery, the catheter is threaded through the left femoral artery and is positioned directly above the thrombus). With this placement, the thrombolytic agent can be injected directly into the thrombus, facilitating lysis of the clot. With the catheter-directed approach, the systemic concentration of the thrombolytic agent and the dosage required are decreased, thus decreasing hemorrhagic complications.7
The catheter may be a single-lumen or a coaxial (double-lumen) system. The dose of reteplase depends on the type of catheter used . With a single - lumen CDDT indicates catheter-directed thrombolytic therapy. catheter, a full dose of reteplase is infused , where as with the coaxial system, the dose is split equally between the lumens. A continuous infusion of a low dose or a full dose of heparin may also be used during the reteplase infusion. Many studies7,9,10,12–14,17 have shown that use of heparin facilitates clot lysis and continued lysis after the reteplase infusion is completed. The cost of a 2 0 - unit vial of reteplase is approximately $2150.14."

NURSING CONSIDERATIONS
"Patients undergoing catheter-directed thrombolytic therapy with reteplase are admitted to the intensive care unit for monitoring for hemorrhagic complications. A nurse begins the continuous infusion of reteplase via the catheter immediately after the patient is admitted. A bolus of heparin is given, and a peripheral intravenous infusion of heparin is started.

"Because intracranial hemorrhage is a major complication of thrombolytic therapy (with an overall risk of 1%),7 a neurological examination must be done every hour. Maintaining a blood pressure less than 180/110 mm Hg helps prevent intracranial hemorrhage.19 Retroperitoneal hemorrhage is also a complication that can lead to hypotension and/or death (with an overall risk of 0.3%).7 A physician should be notified immediately if the patient complains of severe back pain.

"Heparin and reteplase are not compatible and thus should not be administered via the same tubing.20 Currently, neither the optimal duration nor the optimal dose of reteplase in catheter-directed therapy is known. Table 3 indicates nursing interventions for many of the potential adverse reactions that can occur during catheter-directed thrombolytic therapy with reteplase. Figure 3 is an example of a hospital’s standard order set for patients undergoing catheter-directed thrombolytic therapy with reteplase. "

[JiffyGriff]

Originally Posted by Zee_RN

NURSING CONSIDERATIONS
"Patients undergoing catheter-directed thrombolytic therapy with reteplase are admitted to the intensive care unit for monitoring for hemorrhagic complications. A nurse begins the continuous infusion of reteplase via the catheter immediately after the patient is admitted. A bolus of heparin is given, and a peripheral intravenous infusion of heparin is started.

"Because intracranial hemorrhage is a major complication of thrombolytic therapy (with an overall risk of 1%),7 a neurological examination must be done every hour. Maintaining a blood pressure less than 180/110 mm Hg helps prevent intracranial hemorrhage.19 Retroperitoneal hemorrhage is also a complication that can lead to hypotension and/or death (with an overall risk of 0.3%).7 A physician should be notified immediately if the patient complains of severe back pain.

"Heparin and reteplase are not compatible and thus should not be administered via the same tubing.20 Currently, neither the optimal duration nor the optimal dose of reteplase in catheter-directed therapy is known. Table 3 indicates nursing interventions for many of the potential adverse reactions that can occur during catheter-directed thrombolytic therapy with reteplase. Figure 3 is an example of a hospital’s standard order set for patients undergoing catheter-directed thrombolytic therapy with reteplase. "

That was awesome!