Intra-arterial thrombolysis/ mechanical thrombectomy (IAT/MT by T6Goo3

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									  Intra-arterial thrombolysis/ mechanical thrombectomy (IAT/MT) procedures

Potential patient for IAT/MT identified
       Fit for GA/ thrombectomy
       Previously independent
       NIHSS>=10 or basilar artery thrombus
       No bleed or sub acute infarct on CT head
       CTA shows large vessel occlusion (ICA/M1/M2/ VA/BA/ PCA)

       Inform IAT/MT consultant on call via switch (Prof Roffe/ Dr. Natarajan/ Dr Sanyal)
       Inform interventional neuroradiologist (Dr Nayak via switch)

If decision made to proceed to IAT:
TIME IS BRAIN 2000 brain cells die per minute of untreated ischaemia!

1. Intravenous thrombolysis
     A&E doctor to start IV lysis immediately unless contraindicated or already running,
        give 80% of calculated dose keep 20% for potential IA use.

2. Get the team
     Keep next of kin on site for consent /queries or establish contact route

       Stroke physician (or radiologist/ A&E doctor of stroke physician not on site) to get an
        anaesthetist (bleep 829 available 24/07) STAT to book case as an emergency (E1)
        and to arrange for an ODA to attend. Make sure you have details of patient at hand.

        If possible, a member from the stroke team should go down to the main
        theatres and book the case as an emergency (this is ideal but not mandatory).

       Radiologist to get radiographer and scrub nurse for the procedure. Set up operating
        trolley and equipment immediately.

       For patients transferred from other hospital inform anaesthetist (bleep 829) as
        soon as call taken so that they can prepare.

3. Prepare the patient (A&E staff/ stroke team/ neuro-interventionalist)
     Discuss procedure
     Complete consent form
     Complete theatre checklist (inside the consent form)
     Put patient into a theatre gown
     Offer bottle or catheterize
     Put in IA line (in A&E or theatre)
     Transfer to neuro-interventnional theatre
    .
4. Prepare for intervention (downloadable from www.thrombolysis.info)
    Start the intra-arterial intervention log (use paper form or
    Theatre team to move patient onto the intervention table
    Theatre team to cover patient with sterile sheets
    Anaesthetist and ODA to commence local/ general anaesthesia
    Neuroradiologist or scrub nurse to clean/ disinfect groin.

5. During / after the intervention
    Complete intra-arterial intervention log (paper form, or Excel data entry file)
    Remove catheter/ intra-arterial line
    Liaise with ASU to ensure a bed is available
    Get a bed tracked to the intervention suite to transfer patient to ASU
    Patients who were ventilated before the procedure may need ITU/MIU.

								
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