- High Alert: Overdose and under-dosage of thrombolytic medications have resulted in patient harm or death. Have second practitioner independently check original order, dose calculations, and infusion pump settings. Clarify orders that contain any of these abbreviations.
- Do not confuse the abbreviation t-PA for alteplase (Activase) with the abbreviations TNK t-PA for tenecteplase (TNKase) and r-PA for reteplase (Retevase). Do not confuse Activase with Cathflo Activase or TNKase.
- Thrombolytic agents should be used only in settings in which hematologic function and clinical response can be adequately monitored.
- Starting two IV lines before therapy is recommended: one for the thrombolytic agent, the other for any additional infusions.
- Avoid invasive procedures, such as IM injections or arterial punctures, with this therapy. If such procedures must be performed, apply pressure to all arterial and venous puncture sites for at least 30 min. Avoid venipunctures at noncompressible sites (jugular vein, subclavian site).
- Acetaminophen may be ordered to control fever.
- Intermittent Infusion: Vials are packaged with sterile water for injection (without preservatives) to be used as diluent. Do not use bacteriostatic water for injection. Reconstitute 50-mg vials with 50 mL and 100–mg with 100 mL using an 18-gauge needle. Avoid excess agitation during dilution; swirl or invert gently to mix. Solution may foam upon reconstitution. Bubbles will resolve upon standing a few min. Solution will be clear to pale yellow. Stable for 8 hr at room temperature. Concentration May be administered as reconstituted (1 mg/mL). Diluent: May be further diluted immediately before use in an equal amount of 0.9% NaCl or D5W.
- Rate: Flush line with 20–30 mL of saline at completion of infusion to ensure entire dose is received. See Route and Dosage section for specific rates.
- Y-Site Compatibility
- Y-Site IncompatibilityCathflo Activase:
- Reconstitute by withdrawing 2.2 mL of sterile water (provided) and injecting into Cathflo Activase vial, directing diluent into powder for a concentration of 1 mg/mL. Allow slight foaming to dissipate by letting vial stand undisturbed. Do not use bacteriostatic water. Mix by gently swirling to dissolve; complete dissolution should occur within 3 min. Do not shake. Solution should be colorless to pale yellow. Use solution within 8 hr.
- Withdraw 2.0 mL of reconstituted solution and instill into occluded catheter. After 30 min dwell time, attempt to aspirate blood. If catheter remains occluded, allow 120 min dwell time. If catheter function is not restored after one dose, second dose may be instilled. If catheter function is restored, aspirate 4–5 mL of blood in patients ≥10 kg or 3 mL in patients <10 kg to remove Cathflo Activase and residual clot. Gently irrigate catheter with 0.9% NaCl.