Safety of the patient following thrombolysis treatment is very important; especially if the patient has sensory inattention or neglect. Simple measures such as avoiding wet shaving helps minimise the risk of minor bleeding.
Falls prevention
Moving the patient to a more observable area of the ward should be considered to minimise the risk of falling. A fall could result in intra-cranial or extra-cranial bleeding and/or injury. Hazards should be identified: agitation, restlessness, confusion, nicotine and alcohol withdrawal. Consider using a falls assessment tool e.g. Cannard, Tinnetti, Falls Risk Assessment Score; if your patient has a fall please inform medical staff immediately – note any bleeding, new bruising or injuries.
Medication
Avoid aspirin, clopidogrel, heparin, warfarin or non-steroidals for 24 hours after thrombolysis – these can be considered after 24 hours if there is no evidence of bleeding. Some medication may increase the risk of bleeding following treatment including non-prescription drugs.
Invasive procedures
Procedures such as catheterisation, injections, nasogastric tube, arterial punctures, central lines or lumbar punctures should be avoided for 24 hours after thrombolysis. Care should be taken when removing indwelling intravenous catheters as there may be excessive bleeding.
