Post-Surgical Intraocular Gas Patient Safety Information Due to the physical and chemical properties of both SF6 and C3F8 intraocular gas, it is important to provide certain precautions to patients following surgery. Within each cylinder of gas, Sonomed Escalon provides 30 patient information cards and 30 patient bracelets to be provided to each patient – please contact Sonomed Escalon at 800-676-0043 should additional cards or bracelets be required. The precautions should be reviewed with the patients to ensure they understand. Patient Safety Card: “WARNING: This important information is provided to you about your eye surgery. You have a gas bubble in your eye. Use of Nitrous Oxide (N2O) or change in atmospheric pressure with a gas bubble may cause an increase in pressure in your eye, which can result in blindness. Advise all health care providers that you have a gas bubble in your eye before undergoing any surgical or dental procedure, or hyperbaric oxygen therapy and have them contact your Ophthalmologist on the reverse side of this card or your bracelet.” “The following restrictions apply until you have been advised accordingly by your Ophthalmologist: • Do not travel in an airplane. Changes in elevation may cause an increase in pressure in your eye, which can result in blindness • Do not travel to a higher elevation or mountain range from a lower altitude. If you have eye pain while traveling, you should change your route to head for a lower altitude. If this is not possible, you should stop until eye pressure equilibrates and pain subsides. • Maintain the proper head positioning as advised by your Ophthalmologist. Incorrect head positioning may cause your surgery to be unsuccessful, glaucoma or cataracts. • Do not remove the bracelet you are wearing because it will alert health care providers about your surgery in case of an emergency. Contact information for Ophthalmologist _____________________ (Name) _____________________ (Number) Date of surgery: _____ / _____ / _____ TR 9138 02/04 Patient Bracelet: “WARNING: Gas bubble in eye. Use of Nitrous Oxide (N2O) or change in atmospheric pressure may cause an increase in IOP resulting in blindness. Consult Ophthalmologist on reverse side of bracelet before treatment” A Subsidiary of Escalon Sonomed Escalon 2440 South 179th Street New Berlin, WI 53146 (T): 800-486-4848 / 262-821-9182 (F): 262-821-9954 www.sonomedescalon.com