Administering Thrombolysis Early Management

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Presentation transcript:

Administering Thrombolysis Early Management Angela Roots Stroke Practice Facilitator Angela.Roots@nhs.net

What have we learnt so far?

What we have learnt so far... Why thrombolyse Inclusion/exclusion Family Medical history/pre-morbid state LAS decision making Assessment (NIHSS) Scans Time

On arrival LAS phone ahead Bleep system activated Stroke team waiting in ED History from LAS & family Admit patient, portable monitoring, CT Scan

What next? Consent IV access Observations Pre-empting risk Dose Administration Communication

Consent Up to 4.5 hours Post 4.5 hours Pt aphasic / confused / mental health problems Family disagrees What would you do??

IV access 2 cannulas Minimise and monitor puncture sites Ask for assistance after 3 failed attempts

Observations hypertensive If DBP>110mmHg or SBP >180 mmHg: IV labetalol 10 -20 mg over 1 minute, repeated after 10 minutes till response Max. total dose 300 mg/24 hours (HR>60bpm) IV GTN (0.5-10mg/hour) and use same target parameters What is your local policy?

Observations hypertensive Higher risk of bleed Avoid rapid drop in blood pressure Monitor heart rate Headache

Observations Blood Sugar levels INR ?cause of neurological deficit Main laboratory CoaguCheck

Plan ahead, what are the risks? Bleeding Puncture sites Wounds GI Cathlabs Deterioration Anaphylaxis Overnight cover Staffing skill mix Ceiling of care

Dose 0.9mg/kg Weight required Estimated vs actual 90mg maximum dose

Estimate the weight 52kg 89.6kg

Dose and administration 10% total dose given as a bolus over 2 minutes then remainder via infusion pump over 1 hour

Dose and administration Keep dose calculation chart handy Ensure clear prescription of total dose or bolus then infusion to avoid confusion once bolus administered Avoid double concentration 1mg/1ml

Dose and administration Often need more than 1 vial of drug so 2 syringes to be completed Monitor for extravasation carefully Keep check on infusion pump rate during the hour Ensure the infusion tubing is flushed slowly at completion to ensure the 2ml in the infusion tubing is administered

Dose and administration Before you give the drug; Stop, stand back, reassess Signs of improvement?

Location ED Resus area Bolus in CT scanning department (fully monitored) HASU ? What do you think?

Communication Patient, family, carers Ward Staffing capacity Skill mix Cardiac monitored bed Bed manager/ site nurse practitioner

Yes! Lets go, time is brain!!! So do you think we should thrombolyse? Yes! Lets go, time is brain!!!

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