Preparing Intracameral Cefuroxime for use in Cataract Surgery
- Slides: 12
Preparing Intracameral Cefuroxime for use in Cataract Surgery Frimley Park Hospital NHS Foundation Trust Surrey, UK Dr William R Tucker BSc MBBS The author has no financial interest in the subject matter of this poster
Purpose • Postoperative endophthalmitis is a rare but devastating complication of cataract surgery. Preoperative antiseptic with Povidone iodine combined with perioperative and postoperative antibiotics is a UK standard of care. However controversy exists over which antibiotics and route to use. • A prospective randomised trial in 16, 603 patients conducted by the ESCRS found nearly a 5 fold reduction in risk of postoperative endophthalmitis when using intracameral cefuroxime compared to controls 1. A smaller study found the incidence of postoperative endophthalmitis was significantly lower in a group given intracameral cefuroxime compared to subconjunctival cefuroxime 2. 1) Endophthalmitis study group, European Society of Cataract & Refractive Surgeons. Prophylaxis of postoperative endophthalmitis following cataract surgery: results of the ESCRS multicentre study and identification of risk factors. J Cataract Refract Surg 2007: 33(6): 978 – 988 2) Yu-Wai-Man et al. Efficacy of intracameral and subconjunctival cefuroxime in preventing endophthalmitis after cataract surgery. J Cataract Refract Surg 2008; 34(3): 447 – 451
Purpose • Despite accumulating evidence that intracameral cefuroxime is both effective and safe 3 the uptake among cataract surgeons has been poor. Chang et al surveyed 1312 surgeons of the ASCRS and found only 6% used intracameral cefuroxime 4. They also found 82% would initiate use if a commercial preparation was available. We believe this represents concerns about making up `home-made` preparations in theatre. • We therefore developed a visual, simple and step by step protocol for preparing cefuroxime at 1 mg/0. 1 ml before intracameral injection at the end of the case. • We present a method for preparing intracameral cefuroxime and provide usage & complication data for cataract operations performed over an 18 month period at a UK hospital 3) Montan et al. Prophylactic intracameral cefuroxime. Evaluation of safety and kinetics in cataract surgery J Cataract Refract Surg 2002; 28(6): 982 – 987 4) Chang DF et al. Prophylaxis of postoperative endophthalmitis after cataract surgery: results of the 2007 ASCRS member survey. J Cataract Refract Surg 2007; 33: 1801 – 5
Method • We designed a flow-chart portfolio using the diagrams and instructions shown on the following pages. This was placed in theatre and used as a guide to preparing the intracameral cefuroxime doses. • Please note this is an OFF-LABEL use of the drug in the UK • After 18 months of use we collected usage and complication data for the local unit where it was utilised. A questionnaire was sent around the nursing staff and surgeons asking about any problems encountered with the technique.
Method Zinacef ® 250 mg 2. 5 ml Syringe Saline 0. 9% 1 ml Syringes 10 ml Syringe Drawing up needles Filter Needles Double drape small trolley
Method Inject this into the Zinacef ® Runner draws up 2. 5 ml of saline into 2. 5 ml syringe Withdraw 1 ml into 1 ml syringe Use a FILTER NEEDLE Shake THOROUGHLY until dissolved
Method First Scrub Nurse takes 10 ml Syringe Fill 10 ml syringe with Saline Using a FILTER NEEDLE
Method Express Saline to 9 ml mark Withdraw plunger to make room Assistant fits NEW FILTER NEEDLE to the 1 ml syringe of Zinacef ® & injects into the 10 ml syringe of Saline held by Scrub Nurse
Method Mix thoroughly Withdraw 0. 4 ml into 1 ml syringe
Method Repeat step for number of cases on list. Cap 10 ml syringe & leave on trolley as reserve Place in instrument Tray. LEAVE RED DRAWING UP NEEDLE ON SYRINGE UNTIL END OF CASE Surgeon will inject 0. 1 ml into lens bag at end of case
Result • Over 18 months intracameral cefuroxime was prepared and used in 3768 routine phacoemulsification cataract operations. • There were no cases of postoperative endophthalmitis over the period of use. • Nursing staff and the surgeons reported no other complications and no difficulty in preparing the doses. • However – please note we cannot accept responsibility if another person uses this method and suffers complications
Conclusion • The use of intracameral cefuroxime is gaining credence as a effective method for reducing postoperative endophthalmitis rates. • At present it seems to be held back by the lack of a commercial preparation and concern over the safest way to prepare it from available supplies. • We have presented an easy to follow, step by step, visual method allowing surgeons to have confidence that a standard safe dose can be prepared by even the most inexperienced theatre staff. • This off-label method of preparing Intracameral cefuroxime has proved to be a popular and safe method of administering prophylaxis against postoperative endophthalmitis
- Miotic drugs
- Blended vision cataract surgery
- Modified monovision cataract surgery
- Aniseikonia
- Nursing management of cataract
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