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Date: Fri, 01 Aug 2014 09:20:20 +0100
From: Alf<alfwhyte@xxxxxxxxxx>
Subject: [optimal] Re: optimal Digest V5 #112
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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Date: Fri, 1 Aug 2014 09:08:23 -0400
Subject: [optimal] Re: optimal Digest V5 #112
From: Stuart Alfred<stuart.alfred@xxxxxxxxx>
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.
