Abstract TP356: Three Tales: Intravenous Tissue Plasminogen Activator Treatment of Acute Ischemic Stroke in Patients with Compressible Procedure Sites.
Background: Stroke is the most frequent neurological disorder and common cause of severe disability compared to other diseases. Intravenous thrombolytic therapy with tissue plasminogen activator (IV t-PA) within 3 hours is currently the standard for treating ischemic stroke patients. Major surgery within the prior three months of acute stroke is contraindicated for IV t-PA. Utilizing the AHA/ASA stroke database “Get With The Guidelines,” we identified three patients given IV t-PA with compressible procedure sites. The complexity of these three unique hospitalized in-patient cases necessitated a collaborative team approach.
Purpose: The aim of this study was to review the initial nursing strategies and stroke team collaboration in administering IV t-PA with compressible procedure sites. Little research has been published on the incidence of patients receiving IV t-PA with compressible procedure sites and potential risk of treatment in this population, therefore identifying a gap in the literature.
Methods: A retrospective chart review between December 2011 and February 2012 was completed identifying three hospitalized patients with acute onset ischemic stroke who received IV t-PA with compressible procedure sites. Four bedside assessment strategies were identified, 1) Initial Neurological Changes, 2) Activation of Stroke Team, 3) NIHSS Score and 4) Neurology Consultation. Rapid assessment by the stroke team of hospitalized patients with acute neurological change is critical in stroke care.
Results: Three of 32 hospitalized patients received IV t-PA with compressible procedure sites. Initial NIHSS scores ranged from 19 to 24, post NIHSS scores ranged from 4 to 14, resulting in no deaths. Similarities reflect discharge orders on chart, onset 09:00 - 12:00, permanent pacemaker, normal INR, mean blood glucose 120mg/dl. Discussion among team members was essential in the decision to administer IV t-PA with compressible sites; significantly reducing neuro disability.
Conclusion: A collaborative team approach in these three complex acute stroke patients demonstrated significant critical decision making in confirming IV t-PA administration and outcomes.
- © 2012 by American Heart Association, Inc.