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Miscellaneous

Acetylcysteine capsules\tablets for the prevention of contrast nephropathy in renal patients - see notes and the Contrast Induced Complications guidelines:Contrast Induced Complications guidelines.
Acetylcysteine injection 20% ampoules for oseophageal preparation during chromoendoscopy
Collagenase clostridium histolyticum (Xiapex). Private patients only.
Dibotermin alfa - for anterior lumbar spinal fusion
Gax-collagen gel (trache-oesophageal fistula repair).
Haemostatic gelatin ('Cutanplast')
Indocyanine Green - Perioperatively during vitrectomy to delineate abnormal macula pathology
Mannitol (Osmohale) - bronchial challenge test
Pralidoxime Mesylate 20% w/v injection (P2S)
P2S is an antidote to poisoning by organophosphate pesticides and nerve agents.Secretin injection - to delineate the pancreatic duct anatomy and exocrine gland functional assessment of the pancreas (unlicenced indication on named patient basis).
Seprafilm (conclusion of laparotomy to be laid underneath wound closure to prevent adhesions. Particularly in patients who are known will require future surgery).
Sterile Maggots - debridement of wounds where surgery is not an option. Initiation by tissue viability nurses only.
Tisseel - for use interoperatively for cerebrospinal fluid leaks (named consultant only). See note.
Thalidomide - post trial patients for caechexia in oesophageal cancer patients
Talc slurry - see link to use for chemical pleurodesis

Notes:

1. Acetylcysteine is frequently used to prevent contrast-induced nephropathy, usually at a dose of 600mg twice daily for 2 days, starting the day prior to exposure to contrast media. Whilst evidence suggests that acetylcysteine appears to be safe and inexpensive, it's efficacy for the prevention of contrast-induced nephropathy remains unproven.

2. Tisseel - hazard with sprayable firbin sealants. Vigilance is required during administration of sprayable fibrin sealants using an applicator attached to a pressure regulator. To avoid potentially fatal air or gas embolism, do not exceed the recommended pressure for the regulator device and ensure adequate distance from the tissue surface.

3. Advice for healthcare professionals:
To prevent life-threatening air or gas embolism during application of a fibrin sealant using a spray applicator, it is important that the following advice is adhered to:

a). The regulator pressure should not exceed 2.0–2.5 bars for Quixil and 1.4–1.7 bars for Evicel, Tisseel Lyo, and Tisseel Ready to Use.

b). Do not spray closer than 10–15 cm from the tissue surface.

c). Changes in blood pressure, pulse rate, oxygen saturation, and end tidal CO2 should be monitored during application because of the possibility of occurrence of air or gas embolism.

Follow manufacturer’s instructions for use of accessory tips when used with these products.

Organophosphate Poisoning

It is very important that P2S is given as early as possible, under any event within 12 Hours of the onset of symptoms of poisoning.

Stocks are available from Designated Holding Centres. Details of these centres can be obtained from the National Poisons Information Service 24 Hour phone line 0844 892 011. Information is also available through the Regional Drug Information Centre Website.

Nerve Agent Poisoning

It is vitally important that P2S be given as early as possible and within one or two ours of exposure if at all possible. Substantial quantities are likely to be required by A&E departments receiving casualties.

Supplies can be obtained from the National Blood service by contacting the hospital blood bank.The National Poisons Information Service 24 Hours phone line 0844 892 011. They hold information on the administration of P2S in these circumstances.

It is vitally important that P2S be given as early as possible, and within one or two hours of exposure if at all possible substantial.