Timing for combined ICG dye & fluorescein injection

Tue, 9 Jun 2015 22:59:39 GMT

I received an inquiry through the Contact Us form that I need your assisitance in responding to.

"What is the timing for taking pictures when you combine the ICG dye and Flourescein in one injection? I have never done an injection with both. Do I need to use less? My patient has very tiny veins and I have to call an IV specialist to come in. "

Thank you
Heather Hurst, COA
Heather051498@live.com

You can either respond to this thread or send Heather a private message.

Thanks in advance for your help!

Barb

Wed, 10 Jun 2015 11:50:32 GMT

Hi Heather,

We do the FA/ICG combo on occasion here in our clinic on the Spectralis. As far as the amount of dye, we use a 5 ml syringe and draw up 2.5 ml of each dye. (Are you familiar with the method of mixing the ICG dye?)

Luckily for your patient, this method of injecting both dyes at once requires only one good 'stick' by your IV team.

Gary

Wed, 10 Jun 2015 15:26:54 GMT

Gary,
Thanks for the info for Heather. Could you address her inquiry about the timing for taking pictures when the combo is used?

Thanks,
Barb

Fri, 19 Jun 2015 12:29:30 GMT

The Spectralis will capture both tests simultaneously, so the device does that part for you rather impressively. In our clinic, our 'timing' is that of the FA. You will find other imagers adjusting their own protocols to fit their particular situation. Some folks will shoot more images at various times of the test, some extend their 'late'; images further out, etc, etc. I would defer to your physicians to dictate what they want their protocol to be. But for the most part, it's just like shooting an FA.

Don't be intimidated.. it's really pretty cool and you will get more comfortable with each one you do.

Hope this helps (sorry for the delay!)

Fri, 19 Jun 2015 14:44:15 GMT

Thanks so much, Gary. I have passed your comments along.

Fri, 24 Jul 2015 00:19:34 GMT

That's what we've done with our Spectralis as well, though we haven't done any FA/ICG since I've been here, the examples I've looked at on our database show the simultaneous capture of both.

When I was being trained I informed me that when using the 25mg vial kit (which is what we've used here in the past), you mix up a bottle which is good for 2 ICG's, but that both doses needed to be used that day.

Does that sound about right?

This may seem like an odd question, but if you've drawn up Fluorescein for a regular FA and the doctor cancels the order prior to administering the FA, how long can you keep the Syringe with the Fluorescein in it?

Sun, 26 Jul 2015 13:01:20 GMT

First off, I want to congratulate you Paul on becoming one of our very recent OCT-C's. Regardless of whichever OPS certification someone earns, it's always great to see new certificants!

When we shoot an FA/ICG 'combo', we pull out half of the fluorescein dye and keep the remainder handy. Then add to that the ICG mixture. We discard any partial vials when we close shop at day's end.

If the fluorescein is drawn up, ready to go and the doc cancels the test, I will use it on the next FA or throw it out at the end of the day.... whichever comes first.

Gary

Wed, 5 Aug 2015 22:40:15 GMT

I am not sure what is meant by 'timing" of FA /ICG . Is your question about how long the test should be performed for or the timing of taking the individual photographs. We usually take our FA/ICG tests out to 20mins and will perform additional sweeps at 15 minutes in order to catch any hypoflourescence out in the periphery, especially with some of our patients that are suspect for inflammatory eye conditions as hypoflourescence in the late phase ICG are more common with certain eye conditions.

Some Dr's prefer to take the test out to 30 mins but personally I have never seen any extra information pop up after 20 mins.The timing should always be set by the Dr though.

Thu, 6 Aug 2015 00:36:47 GMT

Great exchanges! The Honorable Mr. Miller is very experienced at ophthalmic imaging, and his comments are excellent.

We have several uveitis specialists here as well as a full crew of retinal specialists. We do not do combos anymore as we do our dye injections using a stopcock on the same infusion set. The beauty of that is that you can get excellent focus appropriate for each angiogram, and not have to prioritize one study over the other. When we did combos, the FA was usually the study that was given the priority for best focusing.

The dye appearance time should be the same, understanding that the choroidal flush will be there for each angiogram. We rarely take ICGs out past 15 minutes anymore, but again that is dependent on the physician's preference and the diagnosis.

Hopefully your instrument can do simultaneous studies; but if not, it is a simple thing, using a stopcock, to inject the ICG, record the full circulation phase of the posterior pole, change the instrument setting for FA, love the stopcock lever, and inject the fluorescein. Our physicians prefer this, and the uveitis specialists have said they don't like/want a combo.

Diff'rent strokes, as they say.

Good luck, Heather, and congratulations, Paul!

Paula