Avastin (bevacizumab) for Retinopathy of Prematurity

• Lowest effective dose is not yet clear
• Current UIHC dosing
  • Avastin 25mg/ml concentration (undiluted) and giving 0.25 mg in 0.01 ml

• 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

Med Order detail

• 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

• Coordinate with NICU staff for procedural sedation
• Nursing workflow for UIHC

  PDF

• UIHC Eye Injection Pack
  • Includes plastic cup, cotton-tipped applicators, 4×4 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

1. Tetracaine drops in both eyes
2. Wipe around eyes and face with 4×4 gauze soaked in betadine
3. Inspect syringe ensure plunger in proper location to deliver 0.01 ml (waste overfill)
4. Place lid speculum
5. Place drops of betadine in eye especially in area for injection with soaked cotton tip applicator
6. Grasp eye with toothed forceps to stabilize eye
7. Hold syringe vertically and enter about 1 mm from limbus, aim posteriorly to avoid lens
8. Slowly depress plunger and when drug delivered, retract needle
9. Place new betadine soaked cotton tip applicator over injection site and hold pressure for a few seconds.