• Procedure Summary

  • Arterial injection of 5 mL Calcium Gluconate (CG):

    • 10% CG solution (940 mg/10 cc) diluted to 5 cc aliquots of 1 mg/kg (0.025 mEq Ca/kg)

    • UNC Protocol:

      • • Receive one vial of CG from the UNC Pharmacy: One vial (10 mL) contains 100 mg/mL = Total 1000 mg of CG

        • Mix with saline and make a 5-mL solution containing 1mg/kg (patient's body weight) of CG

        • The formula to calculate the saline volume (SV) for the entire saline bag using the patient's body weight (BW): SV (mL) = (5000 - 10*BW) / BW

          • Example: If the patient's body weight is 70 kg.

            • SV (mL) = (5000 - (10  x 70) ) / 70 = 61 mL

            • Remove 39 mL saline from a 100-mL saline bag and inject the entire vial of CG into the bag. Then, draw 5 mL of solution from the bag and put it in a 5 mL syringe containing 70 mg of CG.

  • The target arteries for calcium gluconate infusion:

    • Proximal splenic artery

    • Mid splenic artery

    • Distal splenic artery

    • Proper hepatic artery

    • Gastroduodenal artery

    • Superior mesenteric artery

  • Collecting a series of samples from the hepatic vein:

    • 0 second: baseline sample before calcium gluconate injection

    • 30 seconds after infusion

    • 60 seconds after infusion

    • 90 seconds after infusion

    • 120 seconds after infusion

    • 180 seconds after infusion

    • Five-minute intervals between arterial stimulations will allow the insulin level to return to the baseline.

Catheters & Access for Procedure:

• Left radial arterial access: Barbeau test required.

• 5-F radial sheath

• 5-F MG-1 125-cm catheter

• 5-F MG-2 135-cm catheter

• Left groin preparation for femoral venous access

• 5-F, 10-cm standard vascular sheath for femoral venous access

• 5-Fr 65-cm, 80-cm Cobra-2 catheter

• 2.8-Fr ProGreat Microcatheter & Fathom micro guidewire

• Hole-punch device

For Discharge:

• None

Reference:

• Zhao K et al. Essentials of Insulinoma Localization with Selective Arterial Calcium Stimulation and Hepatic Venous Sampling. J Clin Med. 2020 Sep 25;9(10):3091.