Monitor patients during and post Activase® administration

The recommended treatment dose of Activase is 0.9 mg/kg (not to exceed 90 mg total treatment dose) infused over 60 minutes. 6

  • 10% of the total treatment dose should be administered as an initial bolus over 1 minute
  • The remaining treatment dose should be infused intravenously over 60 minutes
Administering Activase: A step-by-step guide
Step 1:

Inspect the solution for particulate matter and discoloration prior to administration.

INSPECT SOLUTION
Step 2:

To ensure proper dosing, discard excess by removing any quantity of drug in excess of that specified for the patient's treatment. Be sure to insert the needle into the keyhole port of the vial top, away from the puncture site made by the transfer device, and do not prime the syringe.

DISCARD EXCESS
Step 3:

The bolus treatment dose is 10% of the 0.9 mg/kg treatment dose. Prepare it one of the following ways, using a syringe and needle:

PREPARE BOLUS
REMOVE FROM Y-SITE

Remove the treatment dose from the Y-site injection port on the infusion line after the infusion set is primed.

OR REMOVE FROM VIAL

Remove the treatment dose before the vial is attached to the infusion set. Be sure to insert the needle away from the puncture site made by the transfer device.

Do not prime the syringe.

Step 4:
100-mg vials

Insert the spike end of an infusion set through the center of the stopper of the vial of reconstituted Activase, using the same puncture site made by the transfer device.

INSERT SET THROUGH CENTER OF STOPPER

Peel the clear plastic hanger from the vial label. Hang the Activase vial from the resulting loop.

PEEL PLASTIC HANGER
HANG ACTIVASE VIAL
50-mg vials

Administer using either a polyvinyl chloride bag or a glass vial and infusion set.

Step 5:

Prime infusion set tubing with Activase solution and administer initial IV bolus over 1 minute.

PRIME INFUSION SET
ADMINISTER BOLUS
Step 6:

Administer remainder.
Infuse the remaining 90% of the 0.9 mg/kg treatment dose over 60 minutes. The infusion should begin immediately following the bolus treatment dose.
Activase (bolus and the remainder of the treatment dose) can also be administered using an infusion pump. Make sure to prime the pump tubing with Activase solution so that the infusion begins immediately following the bolus treatment dose.

ALTERNATE METHOD USING INFUSION PUMP
Step 7:

Clear the line.

There are two common practices for ensuring that the full treatment dose is delivered 16:
1. Spike a small bag (eg, 50 mL) of 0.9% Sodium Chloride, U.S. Pharmacopeia (USP), with end of the Activase infusion set when the Activase vial is empty. The infusion should continue at the same rate.

SPIKE 0.9% SODIUM CHLORIDE BAG

2. Program an infusion pump to flush the IV tubing following administration of treatment dose.

Activase is for intravenous administration only. Extravasation of Activase infusion can cause ecchymosis or inflammation. If extravasation occurs, terminate the infusion at that IV site and apply local therapy.

Do not add other medication to solutions containing Activase.

NEXT: Know what to look for when monitoring patients during and after administering Activase >

DID YOU KNOW?

  • The FDA stated that “tPA” is the abbreviation for the drug class that encompasses all tissue plasminogen activators. To avoid confusion and medication errors, it has directed healthcare professionals to use either the brand name, Activase, or the generic name, alteplase, in written prescriptions and verbal orders. 12
  • During and following Activase administration for the treatment of acute ischemic stroke (AIS), frequently monitor and control blood pressure. 6