Fluorescein angiography (AGF) is a diagnostic test used in ophthalmology to aid interpretation of retinal pathology. It is used primarily in diabetic retinopathy and macular degeneration (AMD).
Angiography, retinal Rate circulation and the State Integrity pigment epithelium. The AGF is based on the phenomenon of fluorescence Physical possessing certain substances.
This test does not require Hospitalization is Necessary But dilate the pupils for what is recommended always come accompanied. Patient will come from Su Casa breakfasted, and thus better tolerated test.
For the realization of fluorescein angiography, the first is to ask the patient if one has been subjected some other angiography or contrast test, inquiring about possible allergic Likewise Background and Adverse Reactions.
The AGF consists of intravenous injection in the dye, fluorescein sodium, which is transported in the blood of both freeform As bound to albumin. Diluted solutions absorb light with a peak wavelength of 480 nm (blue) and issued with a wavelength of 530 nm Maximum (yellow-green). FILTERS using reasonable, the exciting light can be separated from the emitted light, being this phenomenon Base AGF.
5 ml of fluorescein solution are injected intravenously 10-20% one catheter through the vein. After the PERIOD 15-20 sec. the dye in the eye and ovations transit through arteries and retinal choroidal, photographed for later study appears. Some Points of Special Interest delay or lack of Filling Blood Vessels and areas of hypo- or hyper-fluorescence.
It is used in the following diseases: Macular Degeneration Senile (AMD), diabetic retinopathy, hypertension, vascular disease of the choroid, peripheral ischemic retinopathies, choroidal neovascularization, vessel occlusion of retinal degenerative myopia, chorioretinal folds, macular hole, hereditary dystrophies, inflammations of the pigment epithelium, inflammatory diseases of the retina and choroid, optic disc pathology and tumors of the retina and choroid.
The role of the nurse involves: strengthening the information provided earlier by the doctor, explaining what the test and obtain informed for the realization of the AGF consent. After giving informed consent and explained what the test is given to sign the patient (a companion or family member if the patient does not see), and gets into the patient's history.
Material needed for vein puncture
Informed consent. Compressor. Gauze (need not be sterile. Povidone. Gloves (need not be sterile) can be made of latex or vinyl. Catheter Vasocan BRAUN 22 G1 (0.9 x 25). Cap or plug (can be yellow or blue). Eye Drop (tropicamide, phenylephrine,). Syringe 5 cc., one for the injection of fluorescein and another to fill it with 5 ml. of saline (to happen later fluorescein injection, so there are no crystals of the above product. it has no scientific basis, but the patient appreciates it).
Having always on hand corticosteroids 40 mgr. E.V.
It is necessary to inform the patient that the skin and urine will be colored for a few hours until all the dye is removed, in the case of AGF.
Start the Procedure
Dilating both eyes and trying to calm the patient. Usually dilated with eye drops tropicamide and phenylephrine, after 10 minutes it was back to take a couple of drops in both eyes, it makes them out to the waiting room and told to close both eyes a couple of minutes to help dilate before.
Insert an intravenous catheter and administering the injection of fluorescein dye; looking at the patient's side effects throughout the course of the procedure until the test. Remove the catheter and dismisses the patient with verbal instructions about possible side effects and informing how to handle them.
Slowly inject the dye, and 19 seconds reaches the retina. The patient may have nausea (No vomiting) that are passed to several seconds. If you have nausea, you sit in the chair and makes vacuuming in and, passes quickly.
5 ml are injected. Fluorescein solution 10% intravenously through a catheter. After a period of 12-20 sec. the dye appears in the eye and transit is observed through the choroidal and retinal arteries, photographed for later study. This is a dynamic study demonstrating vascular anatomy and its variations, and their pathological changes. They are points of special interest for the delay or lack of filling of blood vessels and areas of hypo- or hyper-fluorescence.
It is intravenous injection of a dye, fluorescein sodium, which is carried in the blood both free form and bound to albumin. Dilute solutions absorb light with a maximum wavelength of 480 nm (blue) and emit a peak wavelength of 530 nm (yellow-green). Suitable filters used, the exciting light can be separated from the emitted light, this phenomenon being the base of the AGF.
The test is performed
92% of patients tolerate well the test. The remaining 8% have nausea (no vomiting).
Side effects angiographic test are twofold. Patients get their yellow skin which disappears within hours. The first urination is yellow phosphorite as the dye is injected and may be 48 hours peeing dark (like orange kas). You may advise the patient to drink plenty of fluids to speed removal.
When the test is completed and withdrawing the catheter placed them, I tell them to squeeze five minutes into the puncture site sitting in the waiting room and then they go to make an appointment for the doctor, for laser or given the result with photographs to take him to the doctor or health center specialist. In addition, the patient is dismissed with verbal instructions about possible side effects and informing how to handle them.
NURSING CARE USED TO REDUCE THE LEVEL OF ANXIETY suffered by these patients.
- Puncture site pain if the dye extravasation.
- Nausea, vomiting and dizziness, even unconsciousness.
- Rare serious reactions, no risk if:
- Heart disease.
- Respiratory disease.
- Drugs for hypertension and heart.
- Unusually severe or fatal shock during examination or shortly thereafter.
- Advisable to wait in the room 10 minutes after the test.
- Infection puncture area
What to do about an extravasation?
- Fluorescein suspend injection
- Removing the catheter
Mild systemic complications
- Nausea and / or vomiting
- Vagal syndrome
- Perioral edema and / or periorbital
- Dry mouth or increased salivation
- Metallic taste
- Dizziness or lightheadedness
- 92% of patients tolerate well the test. The remaining 8% have nausea (no vomiting).
- It is the adverse effect that occurs more frequently (5% of cases).
- Urticaria is mild
- Antihistamine and corticosteroid
What to do in a vagal syndrome?
- Loosen clothing
- Administer oxygen
- Taking constant
- Medication administration
Performance against a serious systemic complications
- Discontinue administration of fluorescein
- Ask for help
- Lay the patient
- Keep venoclisis
- Maintain clear airway
- Establish oxygen therapy
- Take vital constants
- Absolute contraindications
- Severe renal impairment
- Severe hypertension
- Severe hepatic impairment
- Bronchial asthma
- Pregnant women
- Lactating women