Table 4 A step-by-step WSES protocol for performing an effective ICG Fluorescent Angiography in the Emergency Setting
Step | Description |
|---|---|
1. Dilution of ICG | Preparation: Reconstitute the ICG vial with sterile water or normal saline according to the manufacturer's instructions to achieve the desired concentration |
Mixing: Ensure the solution is thoroughly mixed for consistent concentration. Protect the solution from light to prevent degradation | |
2. Dose of Administration | Recommended Dose: Administer ICG at a dose of 0.2 to 0.5 mg/kg body weight |
Standard Protocol: Typically translates to 10–25 mg of ICG for an average adult, adjusted based on weight and the clinical scenario | |
3. Timing of Administration | Timing Before Imaging: Inject ICG intravenously 30 s to 2 min before imaging, as fluorescence appears rapidly post-injection |
Emergency Adjustments: Administer ICG as early as possible in critical situations, adjusting timing based on the urgency of the clinical situation | |
4. Injection Point | Intravenous Injection: Administer ICG through an intravenous line, preferably via a central line or large peripheral vein for rapid distribution |
5. Time Acquisition of Images | Imaging Window: Begin acquiring images immediately after ICG administration, as fluorescence peaks within 1 to 2 min, providing optimal visualization |
Real-Time Imaging: Perform real-time intraoperative imaging to assess tissue perfusion dynamically during the procedure | |
6. Interpretation | Qualitative Interpretation: |
- Visualization of Perfusion: Successful ICG angiography shows bright fluorescence in well-perfused tissues, helping to identify viable areas | |
- Anomalies: Areas with reduced or absent fluorescence suggest compromised blood flow, requiring further evaluation or immediate intervention | |
Quantitative Interpretation: | |
- Fluorescence Intensity Measurement: Quantify fluorescence intensity to objectively assess tissue perfusion. Lower intensity may indicate ischemia | |
- Time-to-Peak Fluorescence: Measure the time taken for fluorescence to peak post-injection. Prolonged times suggest compromised perfusion |