Name of the Procedure:

Intravenous Tissue Plasminogen Activator (IV tPA) Not Initiated Within Three Hours (<= 180 Minutes) of Time Last Known Well for Reasons Documented by Clinician

Summary

This refers to instances where the clot-busting drug, tissue plasminogen activator (tPA), is not administered through an intravenous line within three hours of a patient last being seen well for treating a stroke, due to specific documented reasons.

Purpose

• Treat acute ischemic stroke to dissolve blood clots and restore blood flow to the brain.
• To document and understand why certain patients did not receive IV tPA in the critical 3-hour window.

Indications

• Acute ischemic stroke symptoms, such as sudden weakness or numbness on one side of the body, confusion, difficulty speaking, or loss of balance.
• Patient criteria that may make IV tPA inappropriate, such as bleeding risks, recent surgery, or pre-existing conditions as documented by the clinician.

Preparation

• A thorough assessment by a healthcare provider to determine eligibility for IV tPA.
• Diagnostic tests such as CT or MRI scans to confirm the type of stroke and rule out bleeding.

Procedure Description

• Normally, IV tPA involves administering the drug via an intravenous line to dissolve the clot in brain blood vessels.
• In cases documented by G8601, tPA administration does not occur within the critical 3-hour window due to specific reasons like patient conditions, contraindications, or decision-making delays documented by the clinician.

Duration

• Typically, the initial assessment, diagnosis, and decision-making regarding tPA administration should be done rapidly, often within 60 minutes.

Setting

• Emergency department of a hospital, often in a specialized stroke unit.

Personnel

• Neurologists, emergency physicians, radiologists, nurses, and other specialized healthcare professionals.

Risks and Complications

• For procedures involving IV tPA, risks include bleeding in the brain, other bleeding complications, and allergic reactions.
• In documented cases where tPA is not given within 3 hours, the primary risk is continued or worsened stroke symptoms and potential for increased brain damage.

Benefits

• Timely administration of tPA can significantly improve recovery outcomes and reduce long-term disability.
• Proper documentation (G8601) ensures understanding and appropriate decision-making in nuanced medical scenarios.

Recovery

• Individualized post-procedure care depending on whether tPA was administered or not.
• Continuous monitoring in an intensive care unit or stroke unit.
• Rehabilitation and follow-up appointments as necessary.

Alternatives

• Other clot-dissolving medications administered outside the 3-hour window, such as mechanical thrombectomy.
• Antiplatelet or anticoagulant medications.
• Each alternative has its own set of risks and benefits that should be discussed with a healthcare provider.

Patient Experience

• Patients may experience anxiety and stress during acute stroke treatment.
• Pain management is usually not a primary concern as the procedure is not inherently painful.
• Comfort measures include reassurance and care from healthcare professionals and support systems.