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Second Opinions > Adding epinephrine to BSS?

Adding epinephrine to BSS?

Does anyone add epinephrine to the 500ml bottles of BSS for cataract phacoemulsification cases? Alcon doesn't support additions to this solution. Has anyone else stopped this practice based on these directions?

Started by: Debbie G. (OR Manager/Supervisor) at September 4, 2012 (11:50 am)

Comments and Responses

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does anyone know long epi 1:1000 is good for after being added to the 500ml BSS? Someone just stated on this site"one hour". The last ASC I was at stated 6 hours( maybe only for retinal cases)? Current facility staff stated all day is ok.???

Nancy S.

Nancy S. (Other) at August 4, 2015 (5:54 pm)

Because of the restricitions on medication compounding we have given up adding epinephrine to the BSS. I never thouhgt the surgeons could do without the Epi in the BSS but we have found that the majority of time the pupil is sufficiently dilated with topical dilating drops. Occassionally a physican may request Intracamaral Epinephrine. This is drawn up at the time it is used.
I Kelly, RN (Dir of Regulatory Compliance, ASC)
Barnet Dulaney Perkins Eye Center

I. Kelly (OR Manager/Supervisor) at June 20, 2013 (12:57 pm)

One of our eye surgeons showed a copy of the BSS bottle label to Dr. Nick Mamalis from the Moran Eye Center at U of Utah re: no additives. Dr. Mamalis has been one of the tope researchers on TASS. Dr. Mamalis said that verbiage was put on the BSS bottle label back when there was BSS Plus and that required an additive. This bottle was not the BSS Plus and therefore was not to have the additive. He said there is not a problem with adding epi or Vanc and said we could quote him.

Shirley R. (OR Manager/Supervisor) at June 19, 2013 (2:12 pm)

One of our eye surgeons showed a copy of the BSS bottle label to Dr. Nick Mamalis from the Moran Eye Center at U of Utah re: no additives. Dr. Mamalis has been one of the top researchers on TASS. Dr. Mamalis said that verbiage was put on the BSS bottle label back when there was BSS Plus and that required an additive. This bottle was not the BSS Plus and therefore was not to have the additive. He said there is not a problem with adding epi or Vanc and said we could quote him.

Shirley R. (OR Manager/Supervisor) at June 19, 2013 (2:10 pm) [last edited on June 19, 2013 (2:11 pm)]

We still do but I would love to know more about this. Do you have more information?

Vanessa Lyons (OR Manager/Supervisor) at June 19, 2013 (12:44 pm)

We are still using epinepherine and are unable to get the preservative free. Reading this, I am going to approach the surgeons in this area. Have you seen any literature on the discontinuation?

Regina Blount (Director, Surgical Services/Director of Nursing) at March 11, 2013 (3:57 pm)

We still add Epi to our BSS

Rita J. (Director, Surgical Services/Director of Nursing) at February 21, 2013 (1:54 pm)

We currently add Preservative Free .3ml epinephrine (1mg/ml) 1:1000 per 500 ml Bottle of BSS Plus for every Cataract Procedure. Does it matter? It is suppose to keep the iris dilated longer. However, it is hard to tell when a procedure typically only lasts 30 minutes. With patients on Flomax, it does not make much of a difference it seems. We end up using iris retractors of some sort to mechanically dilate the pupil usually.

Richard S. (Other) at February 21, 2013 (12:57 pm)

Since we can no longer get the perservative free epinephrine 1:1000; we have stopped adding it to the BSS. We have not noticed any difference.

Barbara Marco (Administrator/Director/Manager/Owner/Exec. Officer) at December 21, 2012 (3:40 pm)

Debbie,
We do the samething at our ASC. I hadn't thought of researching the product insert. However, I was concerned that adding epi to BSS might be considered compounding, and we don't have a Pharmacist or sterility hood on site.
Do you have any more information on this topic>
Valerie Thiele Adminsitrator Madison Street Surgery Center

Valerie Thiele (Director, Surgical Services/Director of Nursing) at December 3, 2012 (1:30 pm)

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