====== Avastin (bevacizumab) for Retinopathy of Prematurity ======
===== Dosing =====
  * Lowest effective dose is not yet clear
  * Current UIHC dosing
    * Avastin 25mg/ml concentration (undiluted) and giving 0.25 mg in 0.01 ml

==== Ordering ====
  * bevacizumab (25mg/ml) 0.25mg per 0.01 ml
  * 30 unit Insulin syringe with 31 gauge/ 6mm needle 
  * UIHC order set:
    * Currently (as of 3/26/2022) can be found under "NICU Bevacizumab (AVASTIN) for intravitreal injection" medication orders
    * There will be 3 syringes ordered in case a problem occurs with one.
    * This order requires an overfill to 0.11 ml 
{{::avastin_med_panel_order_screen.png?400|}}\\
Med Order detail\\
{{::avastin_med_panel_order_detail.png?400|}}
  * UIHC phone numbers
    * NICU Bay 1: 356-1671
    * NICU Bay 2-3: 356-2888
    * NICU Bay 4: 384-9421
    * NICU level 6: 384-9000
    * NICU Pharmacy Office: 678-5286
    * Children's Hospital Inpatient Pharmacy 356-4300 

==== Procedure ====
  * Coordinate with NICU staff for procedural sedation
  * Nursing workflow for UIHC {{ ::avastin_injection_guideline.pdf |PDF}}
=== Supplies ===
  * UIHC Eye Injection Pack
    * Includes plastic cup, cotton-tipped applicators, 4x4 gauze
  * Betadine 5% ampule
  * Tetrcaine or proparacaine drops
  * Lid specula (one per eye if desired)
  * Toothed forceps (0.12, 0.3 or Bishop Harman, one per eye if desired)
  * Sterile gloves
  * Facemask
=== Suggested Procedure Steps ===
  - Tetracaine drops in both eyes
  - Wipe around eyes and face with 4x4 gauze soaked in betadine
  - Inspect syringe ensure plunger in proper location to deliver 0.01 ml (waste overfill)
  - Place lid speculum
  - Place drops of betadine in eye especially in area for injection with soaked cotton tip applicator
  - Grasp eye with toothed forceps to stabilize eye
  - Hold syringe vertically and enter about 1 mm from limbus, aim posteriorly to avoid lens
  - Slowly depress plunger and when drug delivered, retract needle
  - Place new betadine soaked cotton tip applicator over injection site and hold pressure for a few seconds.  

=== Syringe Delivery ===
{{:30unit_syringe_scales.png?nolink|}}


{{tag>drugs rop}}