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Preparation time for intravitreal injections in clinical practice

Session Details

Session Title: New Drug Treatment and Technology I

Session Date/Time: Friday 18/09/2015 | 11:00-12:30

Paper Time: 11:24

Venue: Thalie.

First Author: : Y.Subhi DENMARK

Co Author(s): :    I. Munch              

Abstract Details

PURPOSE:Vascular endothelial growth factor inhibitors are administered frequently and to an increasing number of patients. A high quality and low cost service requires the intravitreal injection procedure to be safe, simple, and fast. The purpose of this study was to compare the time spent preparing the intravitreal injections when using either pre-filled syringes (ranibizumab) or vials (ranibizumab/aflibercept).

Setting:

Single-center time and motion study at Department of Ophthalmology, Copenhagen University Hospital Roskilde, Denmark.

Methods:

The preparation of 84 intravitreal injections in daily clinical practice was video-recorded. All injection procedures were performed by 3 physicians with experience from more than 100 previous injections. Age and sex of the patient treated and the identity of the physician were noted. Inclusion continued consecutively until 28 preparations had been recorded with ranibizumab pre-filled syringes, ranibizumab vials and aflibercept vials respectively. Exact time stamps were extracted from the videos for each step for each procedure and the total preparation time from the start of the unpacking of the medicine to the syringe being ready for injection was calculated. Data were analyzed with Student’s t-tests and in a general linear model.

Results:

The total preparation times using ranibizumab pre-filled syringes were shortest (P<0.0001) with a mean preparation time of 16.7s (SD 3.1s, C.I. 95%: 15.4s to 17.9s) compared with the preparation times using vials were the mean was 37.1s (SD 3.1s, C.I. 95%: 35.6s to 38.6s) for ranibizumab and 42.1s (SD 7.6s, C.I.95%: 39.2s to 45.0) for aflibercept. The difference in total preparation time between ranibizumab vials and ranibizumab pre-filled syringes was 24.1s (C.I.95%: 21.0s to 27.3s, P<0.0001) when adjusting for age and sex of the patient and identity of the physician. The time spent removing bubbles was reduced with 5.4s (C.I.95%: -7.1s to -3.73s, P<0.0001) when using pre-filled syringes compared with vials with ranibizumab. The adjusted differences between ranibizumab vials and aflibercept vials were not significant.

Conclusions:

Using pre-filled syringes instead of vials saves 24 s in preparation time when performing intravitreal injections. This is due to a reduction in number of procedures and less time spent on removing bubbles when the medicine is delivered in pre-filled syringes. Importance of these results can be seen using our clinic as an example: utilization of each operation theatre could be improved with one extra patient per day if all preparations were PFS. Saving time in the operation theatre is important to ensure that safe intravitreal therapy is broadly available and should be considered when planning a high quality and low cost service.

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