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Thrombolysis Protocol

Thrombolysis is a treatment that dissolves blood clots to restore blood flow, primarily used for acute ischemic stroke within 4.5 hours of symptom onset. Nursing care involves monitoring vital signs, obtaining necessary lab tests, and administering thrombolytic drugs like Alteplase and Tenecteplase, while adhering to strict eligibility and exclusion criteria. Post-thrombolysis care includes monitoring for complications and facilitating early mobilization to improve recovery outcomes.

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Roshni Dahal
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90 views12 pages

Thrombolysis Protocol

Thrombolysis is a treatment that dissolves blood clots to restore blood flow, primarily used for acute ischemic stroke within 4.5 hours of symptom onset. Nursing care involves monitoring vital signs, obtaining necessary lab tests, and administering thrombolytic drugs like Alteplase and Tenecteplase, while adhering to strict eligibility and exclusion criteria. Post-thrombolysis care includes monitoring for complications and facilitating early mobilization to improve recovery outcomes.

Uploaded by

Roshni Dahal
Copyright
© © All Rights Reserved
We take content rights seriously. If you suspect this is your content, claim it here.
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Download as PPTX, PDF, TXT or read online on Scribd
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NURSING CARE FOR THROMBOLYSIS

Anushma Shahi Thakuri


Emergency Department
UNDERSTANDING THROMBOLYSIS
 Thrombolysis is a medical treatment that dissolves dangerous blood clots in arteries
and veins by restoring blood flow.
 It is primarily used in acute ischemic stroke.
 A stroke occurs when a blood vessel that carries oxygen and nutrients to the brain is
either blocked by a clot or burst ( or rupture) ,part of the brain cannot get the blood
and oxygen it needs, so brain cells die.
 Stroke is the third most common cause of death in the developed world.
Thrombolysis is recommended for patients experiencing:
 Acute Ischemic Stroke (within 4.5 hours of symptom onset)
CRITERIA FOR THROMBOLYSIS

Thrombolysis is only done if specific eligibility criteria are met.


 Clinical diagnosis of ischemic stroke
 Time since symptom onset ≤4.5 hours
 No evidence of hemorrhage on brain CT/MRI
Exclusion Criteria:
 BP > 185/110 mm of Hg
 Active internal bleeding
 Platelets count < 100000/ mm3
 INR >1.7(International Normalised Ration) or aPTT >40 sec(Activated Partial
Thromboplastin Time)
 Use of therapeutic dose – LMWH within 24 hours
 NOACs within 48 hours
PRE THROMBOLYSIS NURSING CARE
 Vital sign (every 30 min except BP)
 Blood pressure (every 15 min, maintain systolic
BP 140-180 mm of Hg)
 Pulse
 Respiration
 Temperature
 Spo2
 GCS (every 30 min)
 Weight of the patient
 Intravenous line insertion ( both hand with 18 Gz)
 Glucometer random blood sugar
 ECG
CONT.…

 Draw blood for routine investigation with emphasis on


PT /INR, Platelets, APTT
 Catherization , NG Insertion ( if needed)
 Call MRI room to get ready for urgent MRI
 If patient eligible for Thrombolysis, Get medicine ready
from the pharmacy for infusion to the patient
 Collect lab report
 Thrombolysis Consent
DRUGS FOR THROMBOLYSIS
 Administering Thrombolytic Drugs
 Alteplase (tPA)
 Dosage: 0.9 mg/kg IV (Max 90 mg)
 Administration: 10% as bolus, 90% as infusion over 60 minutes

Tenecteplase
0.25mg/kg bolus over 1 minute
NURSING CARE DURING THROMBOLYSIS
 Vital sign ( every 30 min except BP)
 Blood pressure ( every 5 min, maintain systolic BP 140-180 mm of Hg)
 Pulse
 Respiration
 Temperature
 Spo2

• Watch for GCS (every 30 min)

• Recording and Reporting of drugs used for thrombolysis


NURSING CARE AFTER THROMBOLYSIS
 Maintain post thrombolysis Blood pressure <180/105
 Monitor Vital sign Every 15 min for 2 hours
 Monitor Vital sign Every 30 min for 6 hours
• Vital sign (every 30min except BP)
 Pulse
 Respiration
 Temperature
 Spo2
• Watch for GCS (every 30 min)
THINGS TO BE KEPT IN MIND
 Avoid for 24 hours
 NG Insertion
 Catherization
 CVP Insertion
 Intraarterial catheter insertion

 CT Head: 24 hours of thrombolysis


 Antiplatelets : 24- 48 hours after thrombolysis
WHAT TO EXPECT AFTER
THROMBOLYSIS
 Initial weakness or paralysis
(hemiparesis/hemiplegia) on one side of the
body may start improving within hours to
days.
 Muscle tone changes from flaccidity (early

phase) to spasticity over weeks.


 Early mobilization (within 24-48 hours)

with physiotherapy improves functional


outcomes.

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