19 ! …. and I thought 21 was big, which I NEVER see anyone use anymore, mostly
23 and 25 - occasional 27 on kids. 19 is like sticking with PVC pipe LOL.
From: optimal-bounce@xxxxxxxxxxxxx [mailto:optimal-bounce@xxxxxxxxxxxxx] On ;
Behalf Of Marshall Tyler
Sent: Friday, March 10, 2017 12:33 PM
To: optimal@xxxxxxxxxxxxx
Subject: [optimal] Re: 10% vs 25% Fluorescein
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<mailto: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<mailto: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<mailto: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<mailto: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
