I always preferred the smaller volume to 25% as there may be some anecdotal
evidence that smaller volumes yield less nausea. Remember the days of 10cc
of 5%? Well,... I do. There seemed to be a large drop of nausea when I went
to the smaller, and smaller volumes. Richard Hackel proposed a study of the
temperature of the dye. Room temp v. body temp. I was not done since we had
such a low nausea rate that it would be very hard to show a significant
difference. Also, protocols were a pain to get approved and patient consent
would slow the clinic flow.
So, fast injections consistent with the ability to have a good, easy,
injection site. P.S., I started with 19gu butterflys but was then, due to
staffing preference, downgraded to 21gu.
Thank you,
*Marshall*
Marshall E Tyler, BS, FOPS, X-CRA
On Fri, Mar 10, 2017 at 10:57 AM, Hector Mendez Caratini <
dmarc-noreply@xxxxxxxxxxxxx> wrote:
Stuart:
Ok. I understand your point about “the highest level testing results”. We
all do.
But, for the record, I have been performing Fluorescein Angiographies for
the past 44 years. That is close to 100,000 FAs during my professional
career. In that period of time, I've had the mishap of beating the odds
(the manufacturer’s published data that comes along the printed literature
that accompanies the pharmaceutical product). That means that two deaths
have occurred during an FA procedure. I am certain that other ophthalmic
photographers have had that happen to them too. Therefore, I would not like
that to happen again to me, nor to anyone else in the profession. That is
why I have implemented those injection rate changes that I would like to
address.
I am aware that death is a subject matter that practically no one would
like to publicly address, due to the risks of the legal implications. But,
Optimal and OPS should be concerned with patient safety first, versus high
quality images. Any one out there willing to express their opinions on this
important matter?
Regards to all.
Hector Mendez Caratini, CRA
On Friday, March 10, 2017 11:10 AM, Hector Mendez Caratini <
dmarc-noreply@xxxxxxxxxxxxx> wrote:
Dear Coy and fellow ophthalmic photographers:
I would like to address a new safety concern topic:
It is not comfortable for the patient to rapidly inject (in less than 2 to
3 seconds) a bolus of 5cc 10% fluorescein dye and have him /or her vomit on
you past the 30 seconds mark. It happens too frequently. More than you
would like it to happen.
With the newer acquisition equipment (and old ones too, such as Topcon TRC
50’s), which are much more sensitive, I have been using the following
technique.
To reduce the possibilities of adverse reactions (nausea, vomiting,
urticaria, cardiac arrest and even death!), what I have been doing is
injecting half the dose that comes inside the vial (it doesn’t matter if it
is 10% or 25%, light or dark). It has worked very well for me. With
practically NO allergic reactions a year, versus a lot monthly ones. You
still can get an excellent Early Phase and Mid Phase fluorescein transit.
Where you can easily identify the leaking pathology. Sometimes, the Late
Phase (past seven minutes) images look a bit washed out. But, if you’re
taking into consideration patient comfort and safety, it’s very well worth
the dose.
Another positive side to this equation is that you’re reducing the
monetary costs of the study. That is one vial for two patients. It is nice
to obtain high quality exhibition grade images. But, please remember that
patient safety should always be our main concern. Put yourself (or your
dear family member) inside the patient’s shoes.
Hector Mendez Caratini, CRA
Puerto Rico
On Friday, March 10, 2017 9:47 AM, "Egnatz, Thomas" <tegnatz@xxxxxxxxx>
wrote:
I am posting this for Coy. Sorry about the delay, I have been off Optimal
for a month (new computer).
Tom
*From:* Cobb, Coy, VHACIN
*Sent:* Thursday, February 16, 2017 9:22 AM
*To:* 'optimal@xxxxxxxxxxxxx'
*Subject:* 10% vs 25% Fluorescein
Morning all
Would anyone know of any studies comparing 5cc’s of 10%, verses 3
cc’s of 25% fluorescein ?
Specifically, I’m looking for anything that addresses adverse reactions.
Coy Cobb COT CRA
