TABLE 4.

The management of a vascular occlusion with hyaluronidase

STEPS TO MANAGING AN ESTABLISHED VASCULAR OCCLUSION
1. Video the area in good light ensuring the capillary refill time is checked along the track to the affected artery.
2. Disinfect the skin and mark out the whole area of ischemia.
3. CMAC recommend reconstituting 1,500 units of hyaluronidase with 1ml bacteriostatic NaCl 0.9% or 1–2% lidocaine (or suitable alternative).
4. Infiltrate 1,500 units by needle or cannula (if appropriate) over the course of the affected artery and the wider area of ischemia. Be prepared to use more than one vial at a time if the area affected is significant. It is important to achieve full coverage and focus less on the number of units used. Treat to effect.
5. Apply heat, and massage the area vigorously to aid mechanical breakdown of the hyaluronic acid
6. Reassess capillary refill time and compare with pre-hyaluronidase video. If CRT is still delayed >3 seconds, repeat.

^* The process can be repeated hourly (as a minimum)