[optimal] Re: optimal Digest V5 #112
- From: Alf <alfwhyte@xxxxxxxxxx>
- To: optimal@xxxxxxxxxxxxx
- Date: Fri, 01 Aug 2014 09:20:20 +0100
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>
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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