i agree with mille, but you must be making a lot of money to incur that risk. PM me if you quit, cuz i'll take your job jk
you cant spend your money as well when you are in the slammer with no medical license
i agree with mille, but you must be making a lot of money to incur that risk. PM me if you quit, cuz i'll take your job jk
The fact that our practice discourages the use of dye for epidurals was another one...
When I first arrived at my hospital, the group of anesthesiologists that have been doing ESIs looked at me rather strangely when I told them that I used contrast for ALL of my ESIs(whether interlaminar or transforaminal). The chest thumping of "We know what we are doing and we know when we are in the epidural space" was evident from the first day. Sure, my procedure make take a few moments more, but it's my medical ass on the line. The arbitrary cost of Isovue will not make me change my mind about that. And besides, when I'm teaching the residents/fellows, I hope they appreciate the new approach to an old procedure. They also hardly ever get laterals views for interlaminars, only for transforaminals. I can count too many times, I've had them tell me "I think I've engaged the ligament", only to get a lateral and show them that they still have a ways to go.
Do what makes you comfortable. And do what's best for the patient.
i say this with all seriousness....you need to get a new job....this guy is going to take you down.....why on earth are you continuing to work with him??????
No dye, neuroaxial blocks on patients with plavix, .....come on
I hear you. When I learned of these things I seriously thought I was going to have to quit. Turns out my boss (however cavalier) is a very reasonable guy, and the other partner in the practice is supportive of my viewpoints. We will be going 100% ASRA from here on out. The back of our old referral pads says we'll do Plavix with a 5 day wait, and exceptions were made in the past for certain patients. The new pads will require a full 10 day wait. The balk about dye was based on the notion that I would use one bottle of Omnipaque per epidural/snrb ($50-70). I can split up one bottle of Omni over multiple patients, or go to Isopaque. What I'm worried about now is my exposure to risks that he may take on his own if I become a partner in the practice (in two years). Suffice to say this practice is otherwise very much worth sticking with.[/QUOTE]
I hope so for your sake. Usually when docs are talking about doing epidurals on plavix patients, there are also other serious deficiencies. Remember you can be liable for a partner's/associates mistake.
I hear you. When I learned of these things I seriously thought I was going to have to quit. Turns out my boss (however cavalier) is a very reasonable guy, and the other partner in the practice is supportive of my viewpoints. We will be going 100% ASRA from here on out. The back of our old referral pads says we'll do Plavix with a 5 day wait, and exceptions were made in the past for certain patients. The new pads will require a full 10 day wait. The balk about dye was based on the notion that I would use one bottle of Omnipaque per epidural/snrb ($50-70). I can split up one bottle of Omni over multiple patients, or go to Isopaque. What I'm worried about now is my exposure to risks that he may take on his own if I become a partner in the practice (in two years). Suffice to say this practice is otherwise very much worth sticking with.
We use Isovue at about $30/bottle.
If you become a partner, you take on their risks, no matter where you go. That's why you use the first coupleyears to determine if you are compatible. Sorta like dating your collegues before you marry them in practice.
Which Isovue concentration gives the equivalent opacity to Omni 180? I would assume they would be very similar.
Who do you buy it from?
The Bracco pricing sheet lists 10 mL bottles of Isovue-M 200 for about $62/bottle if you order 10.
No. Too sticky.Thread necromancy:
I found this interesting. Anyone using a common plastic syringe as a LOR syringe? How does it compare to the plastic B.Braun LOR syringe?
Thanks!
Plastic 6cc. "LOR" with contrast under CLO watching it travel from substance of LF to epidural space, the Ligament technique. Totally agree its a waste of money to get special syringe.
Plastic 10cc. No issues. That's how I trained. Now it seems like a waste of money to use glass or epilor.
I use 10cc plastic. No kits. All individual parts dropped on tray.Plastic lor syringe from an epi kit or a la carte?
Plastic lor syringe from an epi kit or a la carte?
Plastic 6cc. "LOR" with contrast under CLO watching it travel from substance of LF to epidural space, the Ligament technique. Totally agree its a waste of money to get special syringe.
hehe I was going to say "thats exactly how I do it" but then I read further and this is indeed EXACTLY how I do it. LOL.
Plastic 6cc. "LOR" with contrast under CLO watching it travel from substance of LF to epidural space, the Ligament technique. Totally agree its a waste of money to get special syringe.
Heck, i could argue LOR is worthless when we have live CONTRAST CLO techniques.Plastic 3cc syringe.
Given that the vast majority on this board don't use glass, you would be hard pressed to claim that as the community standard.
community standard doesnt necessarily translate to "industry" standard, unfortunately. however, i do not know of any organization of physicians that specifically states the type of syringe necessary for LOR...
Surely not, but now you can bill the NDC code and make $500 off the tray. And those glass syringes are re-usable.So, I guess I'm completely wasting tons of money buying ESI trays to get that nice little glass syringe wrapped up with a few syringes and lidocaine. Am I the only one still doing this?