Q: What one precaution should be taken before giving rTPA to patient with acute ischemic stroke?

Answer:  Insert another large bore IV

Once decision is made to administer rTPA to a patient with ischemic CVA, another large-bore intravenous line (in addition to their dedicated TPA line), should be inserted.

For 24 hours after infusion, venipuncture, arterial lines, and insertion of nasogastric tubes should be avoided because of the increased risk of bleeding.

Reference:

Adams H.P. Jr., del Zoppo G., Alberts M.J., et al. Guidelines for the early management of adults with ischemic stroke: a guideline from the American Heart Association/American Stroke Association Stroke Council, Clinical Cardiology Council, Cardiovascular Radiology and Intervention Council, and the Atherosclerotic Peripheral Vascular Disease and Quality of Care Outcomes in Research Interdisciplinary Working Groups. Stroke 2007;38:1655-711.