Name of the Procedure:

Intravenous Tissue Plasminogen Activator (IV t-PA) Treatment Delay
Common name: IV t-PA
Technical/medical term: Intravenous Tissue Plasminogen Activator administration not initiated within three hours (<= 180 minutes) of the time last known well

Summary

Intravenous Tissue Plasminogen Activator (IV t-PA) is a medication used to dissolve blood clots, commonly administered to stroke patients. This specific code (G8602) refers to the situation where the medication was not given within the crucial three-hour window from when the patient was last known to be well, without a documented reason for the delay.

Purpose

This procedure aims to dissolve the blood clot causing the stroke, potentially reducing the extent of brain damage and improving recovery outcomes. Timely administration is crucial as it significantly affects the prognosis.

Indications

• Acute ischemic stroke
• Sudden onset of neurological symptoms like weakness, numbness, difficulty speaking, or facial drooping
• Patients who are within three hours (<= 180 minutes) from the time they were last known to be well

Preparation

• No specific pre-procedure preparation for the delay itself
• Diagnostic tests typically include a CT scan or MRI to confirm the type of stroke
• Assessment of patient's medical history, current medications, and clotting function

Procedure Description

The following steps describe the correct administration of IV t-PA, though this code applies when these steps are not completed within 180 minutes without a given reason:

1. Confirm patient eligibility
2. Conduct diagnostic imaging (CT or MRI)
3. Prepare and calculate the correct dose of t-PA
4. Administer t-PA intravenously
5. Monitor the patient closely for any adverse reactions

Duration

• Diagnostic and preparation steps: 30-60 minutes
• Administration of IV t-PA: Approximately 1 hour Note: The focus here is on the delay beyond 180 minutes without reason.

Setting

• Typically performed in an Emergency Department or specialized stroke unit within a hospital

Personnel

• Emergency physicians
• Neurologists
• Radiologists
• Nurses specialized in stroke care

Risks and Complications

Since the procedure was not performed within the desired timeframe, the following risks increase:

• Worsening of stroke symptoms
• Increased likelihood of permanent disability
• Higher risk of death

Benefits

The benefits of timely t-PA administration include:

• Reduced brain damage from stroke
• Improved chances of recovery This particular scenario lacks these benefits due to the delay in administration.

Recovery

• Specific to t-PA administration: Close monitoring in a stroke unit
• Regular neurological assessments
• Rehabilitation as needed
• Follow-up appointments with a neurologist

Alternatives

• Mechanical thrombectomy for eligible patients
• Antiplatelet or anticoagulant medications
• Supportive care and rehabilitation if t-PA is not administered

Patient Experience

• During the delay: Increased anxiety and stress due to the waiting period
• After delay and diagnosis: Potential worsening of symptoms due to lack of timely treatment
• Pain management and comfort will depend on stroke severity and hospital care policies.