Implementation

• High Alert: Overdosage and under-dosage of thrombolytic medications have resulted in patient harm or death. Have second practitioner independently check original order, dosage calculations, and infusion pump settings

• 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

• Direct IV: Reconstitute with 5 ml of sterile water for injection (direct to sides of vial) and swirl gently; do not shake to minimize foaming. Do not dilute further. Use reconstituted solution within 30 min of preparation

• Rate: Administer via IV line or vein over 2–5 min

• Y-Site Incompatibility: Do not admix or administer via Y-site injection with any other medications

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