QWhat items should be included in an office vascular occlusion kit?

Preparation for a vascular occlusion and ischemic event is imperative when injectables are a part of your practice. An accessible occlusion protocol and the below items will ensure the safety of the patient and support an organized systematic approach to tackling this stressful situation.

Items:

1. At least four vials of Hyaluronidase (Hylenex or Vitrase) refrigerated
2. Lidocaine 2% (no epinephrine)
3. Topical Nitroglycerin paste
4. Bottle of Aspirin 325mg
5. Medrol Dose Pack
6. Hot gel snap packs
7. Local Ophthalmologist contact information (for loss of vision)

Protocol:

1. Stop injecting
2. Massage the area
3. Apply heat, continue to massage
4. Option to apply Nitro paste to area (confirm cardiac contraindications) and massage
5. Inject the occluded area with 150-750 units of hyaluronidase. Mix 1:1 with lidocaine (no epinephrine) or normal saline and massage
6. Inject every 20 minutes until area is re-perfused
7. Option to administer oral steroids