# Alteplase (tPA) infusion

Interfacility monitoring of a stroke thrombolytic infusion and its explicit stop criteria.

Population: Adult & pediatric scope. Scope: IFT-ALS.
Status: published. Source-linked OCEMS summary.
Summary updated: 2026-09-16.
Source checked: 2026-09-16.
Source version: See linked source for document dates and scope restrictions..
Canonical page: https://www.ocmedic.com/guides/alteplase/
Official source: [PR-233 — Monitoring TPA during Interfacility Transports](https://www.ochealthinfo.com/sites/hca/files/import/data/files/75246.pdf)

Independent OC Medic summary. Does not replace the complete policy, current system notices, or clinical judgment.

## Scope & authority

- This page covers alteplase/tPA continuation under PR-233, not field thrombolysis or another thrombolytic product.
- The source’s stop criteria must remain visible during monitoring.

## Source documents

- [PR-233 — Monitoring TPA during Interfacility Transports](https://www.ochealthinfo.com/sites/hca/files/import/data/files/75246.pdf)

## Adult / adolescent

- Receive the sending team’s report: drug, dose, infusion rate, start time, destination, and transfer records. Record baseline consciousness, rhythm, heart rate, and BP.
- Use a transport infusion pump at the rate prescribed by the sending RN/physician. PR-233 does not authorize selecting a new thrombolytic dose in the field.

## Pediatric

- No separate pediatric dose or field-initiation pathway is provided. Pediatric use must be governed by the treating team and transport authorization; do not extrapolate an adult stroke regimen.

## Pediatric dosing availability

- Use the sending team’s patient-specific transport order and authorized scope. The cited transport procedure supplies no independent pediatric initiation regimen.
| Weight | OCEMS pediatric dose |
| --- | --- |
| Any weight | No general pediatric dose under the cited source; follow the applicable order / medical direction. |

## Use, monitoring & documentation

- Assess BP, heart rate/rhythm, and consciousness every 5 minutes. Protect the patient from injury during handling because hemorrhage is a major risk.
- Immediately stop for new altered consciousness, a new headache, uncontrolled vomiting, systolic BP above 180, diastolic BP above 110, or a focal/generalized seizure.
- Record findings and the stop time; proceed to the receiving facility and report the event immediately on arrival. New bradycardia prompts immediate reassessment of vitals and consciousness.