Hyalase Dilution

Dr Tapan’s Experience

One of the observations I have made while training new practitioners over the last 10 years is that although a large number of people know that Hyalase, or hyaluronidase, can be used in an emergency setting, a large percentage of people are unaware of how to reconstitute it and the protocol for using it. In this video, I want to show you how you reconstitute the Hyalase.

Reconstituting Hyalase

We can use Hyalase either electively or in the emergency setting. We begin by ensuring that the Hyalase is in date, and you will be able to see that this vial of Hyalase is 1500 international units. I begin by opening the vial. I will then take a 10 ml syringe and I will fill it with 9 ml of normal saline. I like to use the bacteriostatic saline. There is a lot of debate and not much consensus on the ideal dilution that should be used for Hyalase. Some authors use a 2 ml dilution, others prefer a 5 ml, and my preference is for 10 ml. The amount of Hyalase is what is critical, not the dilution. Again, it will depend to some degree whether you are using it electively or in the emergency setting. You will see that I now have 9 ml of saline.

Hyalase Dilution Tips

I now take a 1 ml syringe, open a 23 gauge needle, and I will use this to draw up exactly 1 ml of normal saline. When I have 1 ml of normal saline in my syringe, after removing all the air bubbles, I will inject this into the vial of the hyaluronidase. I like to repeat this a couple of times to ensure that it is mixing adequately and that all of the Hyalase is mixed in with the saline. Once I have done this, I will then take my 10 ml syringe which has 9 ml of saline, and I will draw up the remaining 1 ml of saline plus the Hyalase that is contained within the vial. Again, I will draw it up a couple of times to ensure adequate mixing.

Now, this 10 ml syringe contains 1500 units of Hyalase. That means that there is 150 units for every 1 ml. I can simply now inject this product back into the vial. If I now take my 1 ml syringe and withdraw 1 ml of this product, you will be able to easily calculate that I have exactly 150 units of Hyalase in this 1 ml of product. Accordingly, 0.1 ml will contain 15 units.

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