Updated 1/2019 TPA Administration Guidelines 1. Please make sure the patient nurse, charge nurse, and primary team are aware that you are going to be instilling TPA into the chest tube. 2. Order the TPA in EPIC (type “alteplase” into orders – select order for “alteplase for chest tube”) 3. When the TPA is at the bedside, do a medication check with the nurse at bedside – verifying that it is the correct patient and medication, crosschecking with the patient’s ID band. 4. Ensure that there is a blue IV cap on the stopcock to keep the system closed and sterile. 5. Scrub the blue stopcock with chlorhexidine. 6. Attach the TPA syringe, and instill into the chest. Remove syringe, leaving blue IV cap. 7. Turn stopcock so that it remains closed and leave the TPA in the chest for an hour. 8. An hour later, turn stopcock to allow chest tube to drain.
TPA Administration Guidelines
Guideline · Aug 2019 · 1 min read
In brief
In brief
Clinical guidelines for administering tissue plasminogen activator (TPA) in acute ischemic stroke, covering dosing protocols, contraindications, and timing considerations for thrombolytic therapy.
Written by the GCMD Library team from the guideline.
Pre-Administration Notification and Verification
Ensure all relevant clinical staff including the patient nurse, charge nurse, and primary team are notified before TPA instillation. Order alteplase through EPIC system and perform medication verification at bedside with the nurse, confirming correct patient identification against the ID band.
Sterile Technique and Administration
Verify blue IV cap is present on stopcock to maintain sterile closed system. Perform chlorhexidine scrub of the stopcock, attach TPA syringe, instill medication into chest tube, and remove syringe while maintaining blue cap in place.
Dwell Time and Drainage Protocol
Close stopcock immediately after instillation to allow TPA to dwell in chest for one hour. After one-hour dwell time, reopen stopcock to resume chest tube drainage.
Statements in this guideline
Notify the patient nurse, charge nurse, and primary team before instilling TPA into the chest tube.
Order alteplase in EPIC by typing "alteplase" into orders and selecting the order for "alteplase for chest tube."
Perform a medication check with the nurse at bedside when TPA arrives, verifying correct patient and medication by crosschecking with the patient's ID band.
Ensure a blue IV cap is on the stopcock to keep the system closed and sterile.
Scrub the blue stopcock with chlorhexidine before attaching the TPA syringe.
Attach the TPA syringe, instill into the chest, remove the syringe, and leave the blue IV cap in place.
Turn the stopcock so it remains closed and leave the TPA in the chest for one hour.
After one hour, turn the stopcock to allow the chest tube to drain.