[optimal] Re: No infiltration...no Fluorescein
- From: "Chuck Etienne" <cetienne@xxxxxxxxxx>
- To: <optimal@xxxxxxxxxxxxx>
- Date: Tue, 8 Oct 2013 20:30:23 -0400
In the 40 years of doing angiograms, I have seen 3 cases of this.
My explanation of this is that the patient was pooling blood in his/her
lower extremities due vaso-vagal phenomenon. None of the patients were
visibly upset or showed any sign of extravasation. It would have been
interesting to have the patients lie down for a minute to see if the dye
showed up then. The dye has to go somewhere! Check to see if the patient
has any skin fluorescence anywhere. That might be a sign of where the dye
went.
Chuck
_____
From: optimal-bounce@xxxxxxxxxxxxx [mailto:optimal-bounce@xxxxxxxxxxxxx] On
Behalf Of Stephen Travers
Sent: Tuesday, October 08, 2013 6:28 PM
To: optimal@xxxxxxxxxxxxx
Subject: [optimal] Re: No infiltration...no Fluorescein
Dear Abul
If that patient had a combined CRVO and CRAO it is likely in my opinion that
you will still see dye as it enters the choroidal circulation in the early
phase of the FA as the choroid is vascularized by two separate arterial
systems, the short posterior
ciliary arteries, which supply the posterior choroid and the long posterior
ciliary arteries, which supply the anterior portion of the choroid and as
these arteries are branches of the ophthalmic artery which is the first
major branch of the internal carotid arteries I expect you will see some dye
in the choroid unless the patient has some occlusion of the carotid artery.
It would be interesting to hear other opinions on this .
Stephen Travers
Heidelberg Engineering
From: optimal-bounce@xxxxxxxxxxxxx [mailto:optimal-bounce@xxxxxxxxxxxxx] On
Behalf Of abul khair
Sent: Tuesday, October 08, 2013 12:13 PM
To: optimal@xxxxxxxxxxxxx
Subject: [optimal] Re: No infiltration...no Fluorescein
I had a little question about that, If the patient had (RA&VO) retinal
artery & vain both occlusions then what?. Is it possible to see any dye in
the retina?.
It is my curiosity to know.Because I have had this type of patient few days
ego,after pushing FA dye i did not see any dye in retina.
Abul Khair
senior ophthalmic photographer
Dept.of ophthalmology
BIRDEM hospital Dhaka 1000
Bangladesh.
_____
From: Hasan Omairah <shagroon@xxxxxxxxxxx>
To: Optimal Freelist <optimal@xxxxxxxxxxxxx>
Sent: Tuesday, October 8, 2013 10:49 PM
Subject: [optimal] Re: No infiltration...no Fluorescein
It happened to me twice so far. Both were females, diabetics, and had weight
problem.
We don't use butterfly needles anymore -quite rarely I guess - instead a
nurse inserts an angio-cath. On both cases the line was in place and there
were no sign of leakage or extravasation. Both patients had fairly good
media, with nicely dilated pupils, their cooperation and fixation was very
good though, nevertheless No dye was visible during any stage, and I had to
check the camera in-between phases just to make sure all are OK. I used a
drop from what was left in the FA ampule, one a small piece of tissue, and
another drop from Benoxinate/fluorescein on another piece of tissue, had it
in-front of the camera and took few shots; still both fluoresce, therefore I
knew the filter, barrier, camera and flash are fine, the culprit was
something else!
We have seen the patients on intervals of (1wk, 1month, 3months, and 1 year)
post injection, and they didn't complain of any pain, skin necrosis, or any
other sign of extravasation, but strangely both experienced discoloration of
their urine, and the discoloration lasted over one day, which I believe was
consistent with the dye being pushed in ok. No skin discoloration on or near
the injection site, no swelling, or anything that is abnormal!
In our practice we use AK-Fluor - fluorescein injection 10% for so many
years and we didn't have any problem with its stability, and both of these
cases were from two different batches. Still; normal FA's were obtained from
both batches on different patients.
Nothing we can think of explained why no dye was visible.
Hasan
<http://arabeyez.info/imgs/Hasan_sig.png>
,-=-=-=-=-=-=-=-=-=-=-=-=-=-=-=-=-=-=-=-=-=-,
, Hasan Omairah AAS COT OCT-C CRA
, Department of Ophthalmology MBC (97)
, King Faisal Specialist Hospital & Research Center
, PO Box 3354
, Riyadh, 11211
, Saudi Arabia
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_____
Subject: [optimal] No infiltration...no Fluorescein
Date: Tue, 8 Oct 2013 09:39:57 -0400
From: slusk@xxxxxxxxxxxxx
To: optimal@xxxxxxxxxxxxx
Has anyone ever experienced a phenomenon where an FA injection did not
infiltrate, or at least we did not have any indication of infiltration, and
no dye infuses into the retinal blood vessels? All camera functions we're
verified and set correctly and the Color fundus and redfree images we're
good.
Just curious.
Thanks
Steve Lusk, CRA
Vistar Eye Center Retina Consultants
5296 Peters Creek Road
Roanoke, VA 24019
Phone: (540) 342-3400 ext. 4731
Fax: (540) 362-1155
slusk@xxxxxxxxxxxxx
www.vistareye.com <http://www.vistareye.com/>
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