Thrombolytic Therapy

Outline Introduction.Prevention (Reducing Your Risk Factors).Definition.Purpose of thrombolytic therapy.Duration or time of procedureWhat happens during thrombolytic

therapy?Side effects.Interactions with some medication.Contra indication (C/I)Complication

IntroductionYour physician may want to give

you a medicine that will help dissolve blood clots in your coronary arteries. This is called thrombolytic therapy. When given promptly, the clot dissolving medicine can sometimes restore blood flow to the heart and prevent tissue death in the Intensive Care Unit for closer observation

Streptokinase ,Urokinase; Tissue plasminogen activator (t-PA)

Prevention (Reducing Your Risk Factors).

Major Risk Factors That Cannot Be Changed

Heredity Gender Age

Major Risk Factors That Can Be Controlled or Changed

Smoking High Blood Pressure Blood Cholesterol Levels Stress

Contributing Factors

Obesity Lack of Exercise Diabetes

Definition.

"Thrombolytic" or "clot-busting" therapy is used to stop a heart attack in its tracks. The drugs prevent or limit heart muscle damage by dissolving clots that block an artery. This opens up the artery and restores the blood flow

Clot-busting drugs must be given immediately after heart attack symptoms begin. The sooner they are started, the more good they do-and the greater the chances are of a full recovery. To be most effective, they need to be given within 1 hour of the start of heart attack symptoms.

Purpose of thrombolytic therapy

Thrombolytic therapy is used to dissolve blood clots that could cause serious, and possibly life-threatening, damage if they are not removed. Research suggests that when used to treat stroke, thrombolytic therapy can prevent or reverse paralysis and other problems that otherwise might result.

Thrombolytic therapy also is used to dissolve blood clots that form in tubes put into people's bodies for medical treatments, such as dialysis or chemotherapy.

What happens during thrombolytic therapy?

physicians and nurses will carefully watch your vital signs and be prepared for an emergency during the procedure, such as bleeding. Initially, you will lie on an x-ray table, and machines will monitor your v/s.

Thrombolytic drugs can be delivered in two ways: through a short catheter inserted in a vein (called an intravenous, or IV, catheter), or through a long catheter that is guided to the clot through your arteries or veins. In emergencies, vascular surgeons often choose the IV method because it is quick and safe to perform outside of a hospital. If your physician chooses to guide the catheter directly to the clot, the end of the catheter may be placed in the vessels leading to your brain, lung, heart, arm, or leg depending upon the location of the clot.

What happens (cont):To deliver the thrombolytic therapy, your

physician will make a small puncture over an artery or vein in your groin, your wrist, or your elbow. This place is called the access site. Before inserting the catheter through this puncture, he or she will clean your skin and shave any hair. This reduces your risk of infection. Your physician then will numb your skin with a local anesthetic and then sometimes makes a small cut or puncture to reach the blood vessel below. Although you may be given some mild sedation, you will usually stay awake during the procedure.

What happens (cont):Next, your physician will usually inject contrast

through the catheter to map your blood vessels with angiography and to locate the clot. You may feel a warm sensation during the injection, which is normal. As the contrast flows through your blood vessels, x-rays are taken. The x-rays do not pass through the contrast, so pictures of your blood vessels appear on a screen. An indication of the clot location will appear as well.

. Because you have no nerve endings in your blood vessels, you will not feel the catheters as they move through your body.

Duration or time of procedure Your physician will periodically monitor the

x-ray screen to see the clot breaking up. However, depending on the size and location of the clot, the drugs your physician chooses, and other factors, this process can take several hours. Sometimes, if you have a severe blockage, the treatment could last for several days.

Side effects.

blood in the urine blood or black, tarry stools constipation coughing up blood vomiting blood or material that looks like coffee grounds nosebleeds unexpected or unusually heavy vaginal bleeding dizziness sudden, severe, or constant headaches Pain or swelling in the abdomen or stomach back pain or backache severe or constant muscle pain or stiffness swollen, or painful joints

Interactions with some medication.aspirin and other medicines for pain and

inflammation blood thinners (anticoagulants) antiseizure medicines, such as Depakote

(divalproex) and Depakene (valproic acid) cephalosporins, such as cefamandole

(Mandol), cefoperazone (Cefobid), and Cefotetan (Cefotan)

Contraindication (C/I)

blood disease heart or blood vessel disease stroke (recent or in the past) high blood pressure (uncontrolled) brain tumor or other brain disease stomach ulcer or colitis severe liver disease active tuberculosis recent surgery, including dental surgery tubes recently placed in the body for any reason recent delivery of a baby or pregnancy . Endocarditis, an infection in the lining of the

heart

Complication

bleeding, arrhythmias (abnormal heart rhythms)hypotension (decreased blood pressure) hematomashypersensitivity to the drug) Allergy (

Other informationThrombolytic therapy is not always

successful. In up to 25 percent of patients, the treatment is unable to break up the clot. This is especially true if the clot has been established for a long time. In another 12 out of every 100 patients, the clot or blockage will re-form in the blood vessel, especially if an underlying reason for the clot to form in the first place is not found and treated.

summaryDefinition.Interactions with some medication.Contraindication (C/I)ComplicationNG DX

Nursing diagnosis :Ineffective cardiopulmonary tissue

perfusion r/t reduce coronary blood flow goal) –relief of chest pain discomfort

Potential ineffective air exchange r/t fluid overload (goal absence of respiratory difficulties)

Nursing diagnosis (cont)Potential ineffective peripheral tissue

perfusion r/t decreased cardiac out put (goal maintenance –attainment of adequate tissue perfusion

Anxiety r/t fear of death change in health status (goal reduction of anxiety)

Riske of

referenceCritical care nursing, Linda D.Urden, fifth

editon,page(755-765)Medical surgical,editon10, page (727-735) Net work.