Thrombolytic Therapy

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

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

Introduction
Your 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)
hematomas
hypersensitivity to the drug) Allergy (

Other information
Thrombolytic 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.

summary
Definition.
Interactions with some medication.
Contraindication (C/I)
Complication
NG 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

reference
Critical care nursing, Linda D.Urden, fifth

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