Keep Injectable Dyes Straight

We're getting questions about how to avoid mishaps with injectable dyes...fluorescein, indocyanine green, methylene blue, etc.

Expect to usually dispense or stock these colorful agents in procedure areas...cath lab, operating rooms, etc.

They're often given before a scan to help clinicians see lymph nodes and other tissue...or to measure function of certain organs.

Question requests to send injectable dyes to patient care units.

For instance, methylene blue shouldn't be added to tube feeds to evaluate delivery in the body. This practice is linked to an increased risk of death.

But methylene blue may rarely be used to treat certain conditions, such as carbon monoxide poisoning...or "vasoplegia," a type of acute low blood pressure.

Watch names and strengths closely. For example, dispensing the wrong strength of fluorescein (AK-Fluor, etc) could cause a patient to get an incorrect dose...and affect imaging quality.

And using methylene blue instead of trypan blue (VisionBlue, etc) for cataract surgeries can cause blindness.

Properly label dyes. Give indocyanine green (IC-Green) a use-by date of 6 hours once it's reconstituted.

And attach a "vesicant" sticker to methylene blue preps...it can damage tissue if it leaks out of an IV site.

Don't automatically substitute one dye product for another...such as when there's a shortage.

For instance, generic methylene blue and the brand ProvayBlue have different strengths, diluent compatibilities, etc.

And methylene blue can cause dangerous drug interactions if it's used in place of indigo carmine.

Minimize waste. Indocyanine green costs around $100/vial...and isosulfan blue is over $1,000/vial.

If staff from the operating room return opened but unused vials, help increase awareness of costs to promote better management of dyes.

Learn more about meds used during procedures with our resource, Dispensing Meds for Surgeries.

Key References

  • https://www.ashp.org/drug-shortages/current-shortages/drug-shortage-detail.aspx?id=47 (6-1-22)
  • Pediatr Emerg Care. 2021 Sep 1;37(9):474-477
  • Medication pricing by Elsevier, accessed May 2022
  • Hospital Pharmacy Technician's Letter. June 2022, No. 380621



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