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This Article Services Email this article to a friend Similar articles in this journal Alert me to new issues of the journal Download to citation manager Google Scholar Articles by Stokes, M. Articles by Donohoe, K. PubMed Articles by Stokes, M. Articles by Donohoe, K.

Buffered Tc-99m sulfur colloid substantially reduces the pain of lymphoscintigraphy injections

¹ Nuclear Medicine, Beth Israel Deaconess Medical Center, Boston, Massachusetts

2028

Objectives: Lymphoscintigraphy involves the injection of Tc-99m sulfur colloid (SC) at multiple sites. Injection protocols vary between institutions, but 8 injections for breast cancer patients or 4 injections for melanoma patients are not uncommon. These injections can be quite painful, which may be related to the acidity of the SC. Almost all patients at our institution have reported some level of discomfort. We have therefore developed a protocol for buffering the SC to derease the acidity of the injectate and therefore the pain of the injections.

Methods: 4% Sodium bicarbonate (Neut) was used as the buffering agent. We tested a range of dilutions: (1) 0.1 ml of Neut was added to a vial containing 0.9 ml of SC with a total activity of 2.2mCi resulting in a pH of 7.5. The stability of three doses of the SC were checked over a 10 hour period. (2) A second dilution of 0.4 ml of Neut and 0.9 ml of SC with a total activity of 2.2mCi resulted in a pH of 8.5. Three doses of the buffered SC were tested for stability.

Results: The pH of the buffered SC was considerably changed from an initial pH of 6.0 to as high as 8.5. The stability of the SC was never less than 90% over 10 hours of testing. While we did not obtain pre- and post-buffering questionnaires, it has been clear to the technologists and physicians at our institution that the SC injections are much better tolerated by our patients since we have buffered the injectate. Pain levels have decreased substantially, with very mild pain reported only occasionally. The reported pain is now more often associated with site sensitivity rather than the sting of the injection.

Conclusions: Buffering SC to a neutral pH does not compromise the quality of the radiopharmaceutical and substantially reduces the pain involved in lymphoscintigraphy injections.

This Article Services Email this article to a friend Similar articles in this journal Alert me to new issues of the journal Download to citation manager Google Scholar Articles by Stokes, M. Articles by Donohoe, K. PubMed Articles by Stokes, M. Articles by Donohoe, K.