Comments in brackets denote activities specific to MGH, or additional commentary
regarding national standards or guidelines. For example:
Activate the Stroke Team
Prior to making any medical decisions, please view our disclaimer.
It is appropriate to mix tPA prior to CT even if it is not used: See below procedure for returning tPA that is mixed but not administered.
Use the calculator for the optimal dose, and check the range by quickly estimating
the dose from the table below
Enter the Weight:
EXAMPLE: Mrs. Jones weighs 150 lbs, which equals 68 Kg. Her total dose is (68 kg * 0.9 mg/kg) 61.4 mg which is equal to 61.4 ml of a 1mg/ml solution. You withdraw 6.1 ml from the 100 ml Actiavse bottle and hand to the Neurologist. Then you withdraw and discard (100 ml- 61 ml) = 39 ml as the waste. The volume of tPA remaining in the Activase bottle is now (61.4 ml - 6.1 ml) 55.2 ml; you set the volume to infuse at a rate of 55.2 ml/hr and start the pump. The pump alarms when the Activase bottle is empty but 11 ml are left in the tubing. In order to complete the dose, un-spike the Activase bottle and spike a bag of saline with the same tubing set-up. Run the pump to allow it to complete the original 55.2 ml volume over the remaining time for the original 1 hour infusion. In this case, it completes the infusion in 12 minutes.
When tPA is mixed but not administered or the packaging is damaged, the reconstituted and unused tPA should be returned for pharmacy credit
Reviewed/Approved by: Schwamm, Lee, M.D. on behalf of ASQT
Last updated: 8/20/2010
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