Bleeding Precautions & Warnings (include in nursing orders as appropriate)

• No IM injections, IV sticks, venipunctures, ABG sticks, urinary catheterizations, rectal temps, arterial punctures, lumbar punctures, NG tube insertions during thrombolytic therapy
• Avoid large dressings over line sites
• Minimal patient manipulation (e.g., avoid physical therapy/CPT/bathing/weighing).
• Use soft toothbrushes, no flossing; use electric razor
• Avoid concurrent use of anti-platelet agents
• Neuro checks hourly for possible ICH. In infants or critically ill patients whose neurologic status is difficult to assess, consider head US or CT to monitor for ICH daily while receiving thrombolytic therapy.
• Limb checks (pulses/Doppler/blood pressure) hourly if applicable
• Line site checks (current and old; IV and sheath)
• Attention to symptoms suggestive of bleed (headache, mental status changes, abdominal pain/distention, back pain, hypotension or tachycardia, etc.)
• While on anticoagulation avoid aspirin, ibuprofen, or other anti-platelet drugs unless specifically indicated as anti-platelet therapy.
• Avoid IM injections, lumbar punctures, arterial punctures unless clinically deemed necessary. Apply pressure after venipuncture until bleeding has ceased.