[optimal] From Denice Barsness reactions to fluorescein
- From: CPMC Ophthalmic Diagnostic Center <cpmceyelab@xxxxxxxxxxxxxxxx>
- To: "'optimal@xxxxxxxxxxxxx'" <optimal@xxxxxxxxxxxxx>
- Date: Fri, 1 Aug 2014 08:44:53 -0700
Have been using 25% with straight 25g needle for years
No problems, great FA's
Spectralis exceedingly sensitive, often entire 2.5cc's not necessary
Our hospital PREFERS we not have crash kit= we have a code blue team on our
floor
Haven't had even emesis for years
Lucky me
Someday, someone will do a truly retrospective/prospective study to answer the
question at last
Why the variance in experiences, reactions
The last one done as old as my gray hair- even then, it was a very small
sampling done under less than scientific criteria
Denice Barsness, CRA, COMT, ROUB, CDOS, FOPS
Ophthalmic Diagnostic Center
CPMC Department of Ophthalmology
2100 Webster Street Suite 212
San Francisco CA 94115
(415) 600-3937 FAX (415) 600-6563
From: optimal-bounce@xxxxxxxxxxxxx [mailto:optimal-bounce@xxxxxxxxxxxxx] On
Behalf Of Stuart Alfred
Sent: Friday, August 01, 2014 06:08 AM
To: optimal@xxxxxxxxxxxxx
Subject: [optimal] Re: optimal Digest V5 #112
Hi Alf,
At our practice I do all my own injections. I certainly understand your
thinking regarding the cannula and respect it. Cost wasn't/isn't our
consideration. I think I will look into your suggestion and re evaluate.
We are a satellite office -in the suburbs etc.- so only rarely do we have
severely sick patients. Are you hospital connected? I haven't had an adverse
reaction aside from slight hives in years. We of course maintain an emergency
kit and have IED. Our physicians are quick to arrive when need would arise.
As id do all my own injections I maintain an above average touch when it comes
to avoiding extravasation. On average I study 7-12 FAs a day with 20 OCTs. If
I relied on the docs to perform my IVs I would go crazy.
On Fri, Aug 1, 2014 at 4:20 AM, Alf
<alfwhyte@xxxxxxxxxx<mailto:alfwhyte@xxxxxxxxxx>> wrote:
Butterfly? Really? Is that because of price?
We always use a cannula. If something goes wrong we need a patent IV entry. A
butterfly just doesn't cut it. We haven't had an extravasion in years using
cannulas with a saline check before the push. No matter how bad the doc/patient
is veinwise. (is that a word?). BTW, half our docs go immediately for the back
of the hand. I don't like it, the patients don't like it. I'd prefer
antecubital too. Sometimes I have to hold the patient's hand up, above heart
level, to get the "rush" of fluorescein entry.
Alf Whyte, Cork, Ireland.
Date: Wed, 30 Jul 2014 09:36:17 -0400
Subject: [optimal] Re: Fluorescein
From: Stuart Alfred<stuart.alfred@xxxxxxxxx<mailto:stuart.alfred@xxxxxxxxx>>
We have gone to using half a dose per vial here on the majority of studies.
Specifically, I use the Spectralis, 25% AK-FLUOR, 23 or 25 gauge
butterfly, 30 degree objective, attempt to use antecubital vein at all
times. My observation over the last . . . two weeks of using half dose is
1) full dose needed with 55 degree objective or patients over 200lbs, 2)
1cc/mL dye dissipates much more rapidly than 2 cc, so late phase images at
3:30-4 minutes. If patient is possible CSR I use full dose for lates at 8
or 10 mins.
My opinion: Annoying having to change an established, proven combination
makes for less than optimal diagnostics! The nuances of our angiography on
such a wide range of patients and pathologies screams 'little room for
variability'. Changing this recipe makes me anxious.
Respectfully,
Stuart
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