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Fluorescein in SROM?From: Anna Nickels (annan@awhonn.org)Thu Jun 5 09:47:01 1997
Dear colleagues, I have been asked a puzzling question by a nurse and I really need some assistance. A perinatologist who consults in her community hospital wants the nurses to perform IV injection of 5cc of Fluorescein dye (the dye used to diagnose scleral tears) to diagnose SROM. Apparently, it will show up green on a vaginal tampon (his warning in the sample procedure he provided stated that "you might expect to see bright green infants"). As the nurse explained to me, he feels that this should replace fern tests. Can anyone provide me with a lit source? We did an exploded lit search yesterday and found only 4 citations. There have been 2 Japanese studies involving the intra-amniotic injection of phenol-sulfonphthalein in 95/96. Another study discussed the use of fluorescein on membranes post-delivery to study the pathophysiology of PROM (1982). The final citation from 1976 was a preliminary report on transabdominal injection of fluorescein to dx SROM. I obviously thought of a lot of questions, but won't go into them here!! Since fluorescein is not listed in the PDR or the drug formulary (at least, we can't find it), I'm not even sure that it can be given IV. The nurse said that the proposed procedure did mention the hazards of extravasation. My advice to her was: 1- make the guy provide the supportive literature, 2- ask the risk management department if special consents would be required, 3- if this is considered a research protocol, would other types of institutional approval be required prior to patient involvement, 4- involve the pharmacy for more information. I wanted to add <VBG> if it becomes policy, warn the media in advance to avoid "little green men" publicity. Seriously, can any of you shed some light on this? If I am out of date on a new practice, please educate me. You can e-mail me privately at annan@awhonn.org TIA Your colleague, Anna Romig Nickels, RNC, BSN AWHONN Senior Practice Specialist Washington, DC annan@awhonn.org
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