Thanks in advance for your help.
Barb McCalley

Here's the inquiry:

Our office is going to do an FA & ICG study on same patient, same day. This will be my first time doing ICG stud. I have been doing FA's for several years. I am wondering protocol when doing both studies at same time, how to mix both dyes (how much of each to inject) as typical Fluorescein dye is 3ml, when to take imaging, flash level etc... We use Cirrus camara from Zeiss Meditec and I have spoken with their tech about this and he suggested to contact you for further help. I have also read up on ICG photography from another website that discusses pulse injection vs bolous injection techniques. Any help/suggestions greatly appreciated. We wish to schedule this patient very soon, so appreciate quick response to this request.

Thank you.

Ruth Bangs
ruthb@envisioneye.com

Welcome aboard.

When is a good time for us to talk.

email me,

Jim Soque

jsoque@hotmail.com

Thanks Ruth for asking this question, we are actually wondering the same thing since we are going to be perfoming ICG's for the first time (hopefully) on Friday. We just ordered a box of ICG which contains 25 MG of the dehydrated ICG, and 10 ML aqueous solvent in glass ampules. I was told by our local rep to rehydrate the whole vial with 2ML of the solvent, and that what is the most common dosage for her clients patients.

What is the best method to calculate, since one box is quite pricey we want to ensure we are not using too much for one patient, albeit it must be used up with the day.

Are we suppose to "flush" with the remaining 8ML of solvent? we do not have the 25% 3 ML FA but we use the 10% 5ML FA. How would we be able to mix the two, or would we push the FA dye (caputure the transit phase) while the ICG is being injected, take FA mids, then ICG earlies at 5 mins, FA at 10, ICG at 10, 15, 20.

Any help that anyone with their expertise would be greatly appreciated!

Looking forward to seeing you all in week :)

Adeline

We are excited about your interest in ICG Dye staining in your photographic studies.

We have been performing combined ICG FA dye tests for over 15 years at Island Retina, and have had great success with the following protocol. 

Of note, we get great results with just 12.5 mg of ICG dye, or, ½ of your 25 mg bottle, to deliver [TD].

Also, the two ‘dyes’ are not mixed together, just introduced one at a time, using the same injection site.

 What is necessary first are:

3 and 6 cc syringes

3 Way Large Bore Stopcock.

10 cc of 0.9% Normal Saline

First, take your ICG dye bottle (25 mg), and mix it with 6 cc of diluent, label, and date.Extract only 3 cc of this mixture, into a 3 cc syringe, to yield a TD of just 12.5 mg of ICG. 

Refrigerate the non-used portion of prepared ICG and, it is usable for up to 36 hours, post.

Attach the ICG mixture onto a 3-Way Stopcock.Draw up the necessary FA dye into a separate 3 cc syringe.

Attach the FA eye to the other side of the 3 Way Stopcock.Attach your appropriate delivery needle to the 3 Way Stopcock, 23 or 25 Gauge.

Engage your ICG system on the camera and ready that timer on the software.Secure your injection site, arm or hand vein.

Start the camera clock with a push of the ICG Dye, and that is your first run, plan on 16-20 minutes total time.

(We do not traditionally shoot a fill phase with ICG Dye, as the critical photos don’t become evident until after 10 mins)

Let that ICG clock run.

Change out the spent ICG dye syringe, and attach the 10 cc of 0.9% Normal Saline (N.S.).

Flush the patient vein with about 5 cc of N.S..

Now, rotate the 3 Way Stopcock, to the loaded FA Dye syringe.

Engage your FA system on the camera and ready that timer on the software.Start the camera clock with a push of the FA Dye, in the traditional manner.

(Perform your flush, if it is customary in your practice)

Take your first FA fill phase photos up to 1- 1.5 mins, both eyes, or what is customary in your practice. Remember, the ICG clock is still running in the background, despite you can’t visually see it.

Re-engage your ICG system filters, and software, and by now, you are at 2.5 mins, capture those ICG photos.

Re-engage your FA system filters, and software, and by now, you are at 2.5 mins, capture those Mid Phase FA photos.

Re-engage your ICG system, and by now, you are at 6 mins, capture these ICG Photos.

Re-engage your FA system, and capture your late FA photos.

[DO NOT CLOSE THE PROGRAM AT THIS POINT…]

Re-engage your IGG system, and photograph additional ICG photos at 8 mins, 10, 12, 14, and 16 minutes and later (20 mins) if necessary.

When you are finished with the ICG, end the run, and close the system at 16+ mins.What you will have is approximately 4 pages of proof sheet of interspersed timed FA photos, and ICG photos, for a total run of 16+ mins. 

Let us know how your both make out, and post your results on this thread.I’m sure other angiographers will want to know your results, or changes to your protocol.

Good Luck,

Jim Soque         

Are you using SLO by chance with the 12.5 Mg? If not what system are you using? We are demoing a standard camera, but I was not sure if this made a big difference.

Thanks again for you response very helpful!

Adeline

Thank you Jim, we are going to definitely look at the half dosage as you mentioned. I have also read about the pulse method so I think we may try both to see what results yield the best images for our system.

Are you using SLO by chance with the 12.5 Mg? If not what system are you using? We are demoing a standard camera, but I was not sure if this made a big difference.

Thanks again for you response very helpful!

Adeline

Hi Adeline,

My rig is 3 TB, OIS Winstation V10.4 , with a Topcon TRC50DX, and a 5 MP OIS Color/ FA, and a Kodak 1.4i for ICG.

Keep us in the loop.

Jim