I agree that a true allergic reaction is going to happen no matter how much is
given - maybe a lesser amount of hives ..., but it will still occur.
I find that the unfortunate side effects - nausea and vomiting - occur more
when the patient is stressed/anxious about having the test done than by rate of
injection. I try to calm them by talking with them through the injection,
focusing on slow breathing to get their mind off what is going on.
As for comfort, once I have the focus in and set, I lower the illumination down
significantly and that helps patient comfort. Nothing you can do about the
flash - you need what you need to get good photos.
It is not worth any legal hassle having single dose vials used for multiple
patients.
I've been taking FA photos for 15~16 years and fortunately never had anything
more than seizures as the most severe.
Lori
Lori Guerette, CRA COA OCT-C
[ justhitanykey@xxxxxxxxxxx ]( mailto:justhitanykey@xxxxxxxxxxx ;)
-----Original Message-----
From: "George Henry, CRA, PBT" <ghenry@xxxxxxxxxxxxxx>
Sent: Friday, March 10, 2017 11:13am
To: optimal@xxxxxxxxxxxxx
Subject: [optimal] Re: 10% vs 25% Fluorescein
I, too, was going to comment on administering multiple doses from a single-dose
vial. There have been some very
large fines and court settlements levied against doctors, clinics, and
hospitals for doing that.
Absolutely NOT worth the risk.
George E. Henry, CRA, PBT (ASCP)
Wheaton Eye Clinic, Ltd.2015 N. Main St
.
Wheaton, IL 60187
630.588.3615
From: optimal-bounce@xxxxxxxxxxxxx [mailto:optimal-bounce@xxxxxxxxxxxxx] On ;
Behalf Of Darrin Landry
Sent: Friday, March 10, 2017 9:20 AM
To: optimal@xxxxxxxxxxxxx
Subject: [optimal] Re: 10% vs 25% Fluorescein
With all due respect, I disagree with your logic. The rate of injection or
amount of dye has nothing to do with adverse reactions to NaFl. If you give
someone a slow injection, it will NOT prevent an allergic reaction (urticarial,
cardiac arrest, death). If they are truly allergic to NaFl, reducing the amount
given will not prevent a reaction.
In my 30 years experience, rate of injection also does not affect rate of
vomiting either. I consistently inject at a rate of 1 cc per second, and have
less than a 5% nausea/vomiting rate.
Also, NaFl is supplied as a SINGLE dose, not multiple dose.
Just my 2 cents
Darrin
Darrin A Landry, CRA, OCT-C
Ophthalmic Consultant
Bryson Taylor, Inc.
207-838-0961
[ www.brysontaylor.com ]( mailto:Darrin@xxxxxxxxxxxxxxxx ;)
From: "Hector Mendez Caratini" <dmarc-noreply@xxxxxxxxxxxxx>
Sent: Friday, March 10, 2017 10:05 AM
To: "optimal@xxxxxxxxxxxxx" <optimal@xxxxxxxxxxxxx>
Subject: [optimal] Re: 10% vs 25% Fluorescein
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
