10.1 Intravitreal Injection Protocol, Antisepsis & Complication Checks

Intravitreal Injection Assisting

An intravitreal injection places medication into the vitreous cavity. The licensed practitioner performs the injection and makes diagnostic and treatment decisions. The technician's responsibility is to make the ordered procedure traceable, protect asepsis, prepare authorized supplies, observe the patient, and close the loop on instructions.

Pre-procedure verification

Use two patient identifiers. Reconcile the schedule, order, consent or authorization status, patient statement, and medication label. Confirm:

• right eye, left eye, or bilateral plan;
• exact medication, concentration, dose, route, and formulation;
• expiration, lot, package integrity, and storage status;
• allergies and the reaction actually experienced;
• recent symptoms, procedures, pressure issues, and clinician-requested measurements;
• lens status or other anatomy when it affects the planned technique.

Any laterality, product, dose, or documentation mismatch stops preparation until the team resolves it. Never alter an order to make records agree.

Medication handling

Use medication supplied or prepared through the approved pharmacy and clinic process. Maintain required refrigeration and light protection. If storage limits were exceeded, quarantine the product and obtain an authorized stability determination; appearance alone cannot establish potency or sterility.

Inspect the syringe or vial, verify volume without introducing contamination, and label every prepared syringe immediately. Do not pool, split, substitute, dilute, or transfer products unless the authorized procedure specifically permits it. Follow single-dose and beyond-use instructions.

Antisepsis and field protection

Hand hygiene, mask practices, clean-lane preparation, eyelid and lash isolation, and ocular-surface antisepsis follow the current injection protocol. Povidone-iodine is widely used because it reduces ocular-surface microbial load. Apply the ordered ophthalmic product at the specified sites and allow the validated contact time. Do not use an alcohol-containing skin preparation on the eye.

If a patient reports iodine, contrast, or shellfish allergy, clarify the substance, route, symptoms, and treatment. Shellfish allergy does not establish povidone-iodine allergy. The clinician decides whether a true prior reaction requires another approach. Aqueous chlorhexidine is not interchangeable with common skin products and must never be improvised.

Keep lashes, lid margin, fingers, talking droplets, bottle tips, and nonsterile equipment away from the prepared site and sterile components. Announce and correct any break.

Site and technique

The pars plana entry site is selected by the practitioner based on lens status, age, anatomy, prior surgery, medication or implant instructions, and technique. Common adult teaching ranges differ for phakic and pseudophakic eyes, but one measurement is not universal. The technician provides the approved caliper or device and does not independently choose the site, needle angle, or treatment eye.

Immediate observation

Follow protocol for gross vision, symptoms, pressure, or perfusion checks. A temporary floater or mild surface irritation may occur, but do not normalize profound darkness, marked pressure pain, nausea, absent arterial perfusion, severe inflammation, or a significant vision change. Notify the physician immediately. The clinician determines whether observation, medication, paracentesis, imaging, or another action is required.

If the patient develops breathing difficulty, hypotension, rapidly progressive swelling, or a multisystem reaction, activate the emergency response and follow the authorized medication protocol.

Documentation and discharge

Record patient and eye, product, dose, lot and expiration when required, preparation source, administration time, personnel, antisepsis, immediate checks, adverse events, and instructions. Use the clinician-approved discharge sheet. Warning symptoms commonly include increasing pain, redness, photophobia, discharge, or declining vision. Activity, water exposure, drops, driving, patching, and follow-up timing vary; give the actual ordered instructions rather than a memorized restriction.

Ask the patient to teach back whom to call and when. A reliable injection visit ends with traceable medication, intact documentation, and a clear emergency pathway.

Time-out, observation, and event documentation

Immediately before the procedure, the team confirms two identifiers, treated eye, medication, dose and route, indication stated in the order, consent status, allergies or prior reactions, and any required lot or expiration data. Laterality marking and the verbal time-out must agree. If the chart, patient, prepared syringe, and time-out do not match, stop and preserve the discrepancy for resolution; familiarity with a recurring patient is not a substitute for verification.

After the injection, perform only ordered checks and observe for the protocol-defined interval. A transient floater or surface irritation may occur, but a technician should not normalize increasing pain, marked redness, photophobia, discharge, a major vision change, or systemic symptoms. Give the approved written instructions and contact route, use teach-back, and document the medication, eye, time, personnel, tolerance, checks, education, and disposition. Never add a universal water, antibiotic, patching, or activity rule that is absent from the treating clinician's instructions.