Q Is it an expected practice for critical care nurses to irrigate an external ventriculostomy drainage (EVD) system with tissue plasminogen activator (tPA) to break up blood clots in the tubing to facilitate drainage, thereby preventing increased intracranial pressure? A new group of neuroendovascular interventionalists have joined our staff and have asked our intensive care unit staff to perform this procedure. I cannot locate any literature that supports whether this is a nursing or a physician practice.

A Laura M. Criddle, RN, MS, CCNS, CNRN, replies:

As the author of the question suggests, there is little information in the literature to provide a simple answer to this complex issue. Since its widespread introduction in the 1990s, the number of indications for recombinant tPA has steadily increased. This drug was initially approved to promote coronary artery reperfusion after acute myocardial infarction. Subsequent approved and off-label “clot-busting” uses include acute pulmonary embolism,...

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