Standard operating procedure

Vascular Occlusion Management Procedure

Step-by-step emergency workflow for recognising and managing suspected vascular occlusion following dermal filler, including the sight-threatening ocular pathway.

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What's inside

This standard operating procedure is fully drafted and structured, ready to brand and complete for your service. It covers:

  • 1. Purpose
  • 2. Scope
  • 3. Recognition
  • 4. Responsibilities
  • 5. Equipment and medicines
  • 6. Procedure
  • 7. Monitoring, follow-up and safety-netting
  • 8. Records and reporting
  • 9. Related documents
  • 10. Review and version control
  • 11. Disclaimer

Legislation & standards it maps to

  • Health and Social Care Act 2008 (Regulated Activities) Regulations 2014, Regulation 12 (Safe care and treatment)
  • Health and Social Care Act 2008 (Regulated Activities) Regulations 2014, Regulation 20 (Duty of candour)
  • Human Medicines Regulations 2012
  • Aesthetic Complications Expert (ACE) Group World guidance on the management of vascular occlusion and visual loss following dermal filler
  • General Medical Council and Nursing and Midwifery Council professional standards on managing risk and emergencies

Who it applies to

All practitioners, prescribers and clinical support staff at [Organisation Name] who inject dermal filler, assist with injectable treatments, or may be first on scene to a patient with a suspected vascular complication.

Glossary

Plain-English explanations of the technical terms and legislation used in this document.

Adjunct
An additional treatment given alongside the main treatment to support or improve it.
Adrenaline (epinephrine)
An emergency medicine given by injection into a muscle as the first treatment for a severe allergic reaction.
Adverse event
Any unexpected or unwanted occurrence linked to a treatment that harms, or could harm, a patient.
Aesthetic Complications Expert (ACE) Group
A specialist group that publishes UK guidance on recognising and managing complications of cosmetic injectable treatments.
Anaphylaxis
A severe, life-threatening allergic reaction needing immediate emergency treatment.
Antihistamine
A medicine that reduces the effects of an allergic reaction.
Antiplatelet
A medicine, such as aspirin, that makes the blood less likely to clot.
Bag-valve-mask
A hand-held device used to push air or oxygen into the lungs of a patient who is not breathing adequately.
Blanching
Whitening of the skin, here caused by the blood supply to that area being cut off.
Calcium hydroxylapatite
A type of dermal filler that is not made of hyaluronic acid and cannot be dissolved by hyaluronidase.
Capillary refill
A quick check of blood flow: after pressing the skin it should regain its colour in under two seconds.
Care Quality Commission (CQC)
The independent regulator of health and social care services in England.
Contemporaneous
Recorded at the time an event happens, or as soon as possible afterwards.
Contraindication
A reason why a particular treatment or medicine should not be given to a specific person.
Cutaneous
Relating to the skin.
Dermal filler
A gel injected under the skin to smooth lines or add volume to the face.
Diluent
A sterile liquid used to dissolve or dilute a medicine before it is injected.
Duty of candour
The legal duty to be open and honest with a person and their family when something goes wrong with their care.
Field defect
A missing or blank area within a person's field of vision.
Glabellar
Relating to the glabella, the smooth area of skin between the eyebrows.
Glyceryl trinitrate (GTN)
A medicine that widens blood vessels, sometimes used to help restore blood flow.
Health and Social Care Act 2008 (Regulated Activities) Regulations 2014
The regulations setting the fundamental standards of safety and quality that registered care providers must meet.
Human Medicines Regulations 2012
The law governing how medicines are licensed, prescribed, supplied and administered in the UK.
Hyaluronic acid (HA) filler
A dermal filler made from a gel that occurs naturally in the body and that can be dissolved by hyaluronidase.
Hyaluronidase (HA-ase)
An injectable medicine that dissolves hyaluronic acid filler and is used to reverse a vascular occlusion.
Infiltration
Injecting a medicine throughout an area of tissue rather than at a single point.
Intramuscular
Given by injection into a muscle.
Ischaemia
A shortage or loss of blood supply to part of the body, which can damage the affected tissue.
Livedo
A blotchy, net-like or mottled discolouration of the skin, here a warning sign of disrupted blood flow.
Medicines and Healthcare products Regulatory Agency (MHRA)
The UK body that regulates medicines and medical devices and oversees their safety.
Near miss
An event that could have caused harm but did not, by chance or because it was caught in time.
Necrosis
The death of body tissue, here caused by a loss of blood supply.
Notifiable event
An incident a provider is legally required to report, such as a death or serious injury.
Occlusion
A blockage; here, of a blood vessel.
Ocular
Relating to the eye.
Off-label use
Using a licensed medicine for a purpose other than the one it is officially approved for, where this is clinically justified.
Ophthalmic circulation
The network of blood vessels that supplies the eye.
Ophthalmology
The branch of medicine dealing with the eye and its disorders.
Ophthalmoplegia
Weakness or paralysis of the muscles that move the eye, causing difficulty moving the eye.
Periorbital
Relating to the area around the eye.
Poly-L-lactic acid
A type of dermal filler that is not made of hyaluronic acid and cannot be dissolved by hyaluronidase.
Prescriber
A clinician legally authorised to prescribe medicines.
Prescription-only medicine (POM)
A medicine that may lawfully be supplied only on the instruction of an appropriate prescriber.
Ptosis
Drooping of the upper eyelid.
Reconstitute
To mix a powdered or concentrated medicine with a liquid to prepare it for injection.
Registered Manager
The person registered with the regulator as responsible for the day-to-day running of a service.
Reticulated
Having a net-like or web-like pattern, used to describe a skin discolouration.
Retinal artery occlusion
A blockage of the artery supplying the retina, which can rapidly cause permanent loss of vision.
Retrobulbar injection
An injection given into the space behind the eyeball, an advanced technique requiring specific training.
Safety-netting
Giving a patient clear advice on what warning signs to watch for and exactly what to do if they appear.
Secondary care
Specialist hospital-based care to which a patient is referred, such as plastic surgery or dermatology.
Standard Operating Procedure (SOP)
A document setting out the agreed step-by-step way a specific task must be carried out.
Vascular occlusion (VO)
Blockage of a blood vessel, here caused by filler compressing or entering the vessel and cutting off the blood supply.
Vasodilation
Widening of the blood vessels, which can help to improve blood flow to an area.
Yellow Card scheme
The UK system for reporting suspected side effects of medicines and problems with medical devices to the Medicines and Healthcare products Regulatory Agency.

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