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How long do you wait before foley or IV placement in patients who have recieved TNK or TPA?

3 Answers
Mednet MemberInvited Expert
Neurology · University of California, San Diego
Answered on

If foley is needed, especially if going to IR, etc., we place it before if possible, but often place it during infusion or even after if needed. 

Mednet Member
Neurology · Cleveland Clinic
Answered on · Updated on

I would not consider IVT a contraindication to placing an IV. It would be more concerning for an arterial puncture but then again we do it all the time when the patient is going for a thrombectomy.

Regarding a Foley, usually, the catheter is placed prior to IVT administration and there should be an indication for it. In this (Chang et al., PMID 28222621) Chinese trial, they found that patients who had urinary catheters placed 1 - 24 hours after IVT, had higher rates of urinary hemorrhage. I also found these guidelines by the Toronto Stroke Networks that recommend placing the urinary catheter 4 hours after IVT infusion (I honestly, do not know what evidence is behind this). There was also this article (Eiskjær Sørensen et al., IDUNN 10.18261/issn.1892-2686-2020-02-02) from Norway if you want to give it a look.

In conclusion, not a contraindication for IVs but place Foley either before IVT or at least 24 hours after for the patient's safety. If the patient it's retaining urine, then a straight cath could be a consideration instead of an indwelling catheter.

Mednet Member
Neurology · University of Colorado, Climate & Health Dept
Answered on

It's not a contraindication. If the patient needs it, place it. There might be some non-life-threatening bleeding at the site.