In-Service for PDE

In-Service for PDE S
Topics
1.  PDE operation
2.  Vascular application – free flap perfusion
3.  Lymph mapping application (off-label)
PDE Operation – How it works
PDE is a near infrared camera that images ICG dye injected into veins
1. ICG is injected and bonds
to Plasma in blood or lymph
fluid
2. Camera is turned on and
emits an “excitation light”
that reacts with the bonded
ICG
3. Bonded ICG reacts and
camera receives image
Tissue
Subject
PDE Operation – Camera Controls
•  Brightness:
Like the brightness on monitor
•  Contrast:
Like any monitor contrast
•  Light Control:
Up and down of LED lights
PDE Operation – Remote Control
•  Who controls – If light is
green than functions of main
head do not work but remote
does
•  Light Control – up and
down of LED lights
•  Brightness – Like the
brightness on monitor
•  Contrast – Like any monitor
contrast
PDE Operation – Default Settings
PDE Operation –
During Surgery
6” – 8”
Camera should be held 6-8
inches from skin surface
Image of dye can
penetrate about 1 cm
beneath the skin
1 cm
PDE Operation – Potential problems
There are several things that will cause the PDE not to function
1.  Halogen Lights:
Interfere with Camera light. Turn off any Halogen
lights in OR. (Fluorescent lights are okay).
Sunlight is also bad.
2. Heparin:
Heparin will prevent the ICG dye from bonding
3. Allergy:
If a patient has a sulfate/iodine allergy they may
react to ICG dye
3. Also note:
ICG dye alone will not be visible with PDE. Dye
must bond to plasma/protein to become visible
PDE in the OR
1.  Open the Mitaka Refill
Kit
2.  Mix the ICG by adding 10
ml solution to the 25 mg of
ICG. Shake gently till
resolved.
3.  ICG is only good for 6
hours after mixed
4.  Draw the ICG mixture into
a 10 ml syringe
PDE Operation – for vascular perfusion*
The PDE can be used to image vascular perfusion
TRAM Flap in Breast Reconstruction
* FDA has cleared PDE for use in visualization of blood flow and the evaluation of
tissue perfusion
Venous administration of ICG Drug for
vascular and tissue perfusion imaging *
* FDA has cleared PDE for use in visualization of blood flow and the evaluation of
tissue perfusion
PDE Operation – in lymph surgery*
The PDE can be used to map the lymph systems. Unhealthy
lymph flow will result in back flow bringing ICG back to surface.
Healthy Lymph Flow
* FDA has not cleared PDE for lymph visualization
Unhealthy Lymph Flow
Administration of ICG Drug for
Lymphatic mapping (off-label)
In surgery, with patient anesthetized:
1. Mix 25 mg of ICG with 10 ml of solution provided with drug.
2. Inject .01 to .02 ml of ICG mixture
into each toe/finger web of the
lymphedematous limb.
3. Seal injection site with tagaderm to
prevent surgeon's hand from
becoming contaminated or take care
that surgeon does not touch the
areas of injection getting ICG on
gloves.
Administration of ICG Drug for
Lymphatic mapping (off-label)
4. Starting with PDE light at 7 and contrast/brightness at their
default setting begin to view the ICG flow up the lymphedematous
limb.
5. The PDE should be about 6-8
inches from patient skin.
Excitation light level may be
adjusted as can Brightness,
Contrast, and Noise Reduction
for optimal imaging.
It is often useful to massage the patient to help ICG flow up lymphs.
PDE in the OR – Sterile Drape
PDE Operation – Cleaning
Wipe the main unit with an ethanol- or isopropanol-dampened soft
cloth or absorbent cotton pad. Clean the camera window with a
soft and clean cloth such as a
lens cleaner.
Do not wipe the camera window
with a stiff or dirty cloth.
If necessary, use an ethanol- or
isopropanol-dampened soft cloth
or absorbent cotton pad.
QUESTIONS?
S

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