• Overdosage and underdosage of thrombolytic medications have resulted in patient harm and/or death. Have second practitioner independently check original order, dosage calculations, and infusion pump settings. Do not confuse the abbreviation t-PA for alteplase (Activase) with the abbreviation TNK t-PA for tenecteplase (TNKase). Clarify orders that contain either of these abbreviations.

• Tenecteplase should be used only in settings where hematologic function and clinical response can be adequately monitored. Avoid IM injections and unnecessary venipunctures. Apply pressure to all arterial and venous punctures for at least 30 min. Avoid venipunctures at noncompressible sites (e.g., jugular and subclavian sites).
  • Avoid invasive procedures, such as IM injections or arterial punctures, with this therapy. If such procedures must be performed, apply pressure to all arterial and venous puncture sites for at least 30 min. Avoid venipunctures at noncompressible sites (jugular vein, subclavian site).
  • Systemic anticoagulation with heparin is usually begun several hr after the completion of thrombolytic therapy.
  • Acetaminophen may be ordered to control fever.

IV Administration:

• IV: Prior to therapy, start two IV lines: one for tenecteplase, the other for any additional IV infusions.
• Intermittent Infusion: Diluent: Vials are packaged with sterile water for injection (without preservatives) to be used as diluent. Do not use bacteriostatic water for injection. Do not discard shield assembly. To reconstitute aseptically withdraw 10 mL of diluent and inject into the tenecteplase vial, directing the stream into the powder. Slight foaming may occur; large bubbles will dissipate if left standing undisturbed for several minutes. Swirl gently until contents are completely dissolved; do not shake. Solution containing 5 mg/mL is clear and colorless to pale yellow. Withdraw dose from reconstituted vial with the syringe and discard unused portion. Once dose is in syringe, stand the shield vertically on a flat surface (with green side down) and passively recap the red hub cannula. Remove the entire shield assembly, including the red hub cannula, by twisting counterclockwise. Shield assembly also contains the clear-ended blunt plastic cannula; retain for split septum IV access. Reconstitute immediately before use. May be refrigerated and administered within 8 hr.
• Rate: Administer as a single IV bolus over 5 seconds.
• Y-Site Incompatibility: Precipitate forms in line when administered with dextrose-containing solutions. Flush line with saline-containing solution prior to and following administration of tenecteplase.