Keep Code Blue, CPR ready for latex reactions

Staff could be patients

Patients sensitive to latex are being encountered more and more now. The sensitivity is a double-edged sword. Since the advent of universal precautions and a subsequent increase in the use of latex gloves by health care workers, there’s been an increase in reported cases of latex-related problems.

Medical intervention for latex hypersensitivity is subcutaneous epinephrine (aqueous 1:1000) unless severe cardiovascular compromise is present. The adult dose is 0.3 ml to 0.5 ml; children’s dose is 0.01 ml/kg with a maximum of 0.3 ml. Airway management, Code Blue, cardiopulmonary resuscitation, and advanced cardiac life support procedures may be necessary.

Once latex allergy is established in an incoming patient, place a vinyl allergy identification "Medic Alert" bracelet on him or her, and advise the patient to warn doctors and dentists in the future about this allergy. Suggest that the patient carry latex-free gloves with him or her for health care workers to use in the event of an emergency. Suggest also carrying an injectable epinephrine kit, or "bee kit," in case of accidental exposure.

Label the patient’s chart, and put a sign on the door. Notify pharmacy and central service units so they can use appropriate procedures when preparing items for the patient. Prepare a latex allergy kit.

Remove all latex items from the patient’s environment. Use latex-free gloves and devices. Do not inject through latex ports on IV tubing, T-connector, buretrol, or IV bag. Place a stopcock in IV lines for injections, and tape over latex ports. Avoid the use of multidose medication vials. If it’s imperative to use vials with rubber stoppers, remove the stoppers using clean technique and withdraw medication directly from the vial using sterile technique.

Wrap blood pressure connecting tubing, pulse oximeter, and temperature apparatus with gauze, or place cotton batting on areas of contact with skin. Use velcro tourniquets, or place gauze under latex ones.

Hospital employees should be evaluated through the employee or occupational health service unit. Staff there should take a careful allergy history and conduct an environmental survey. Refer a suspected sensitivity to an allergist to confirm the diagnosis. Provide a safe alternative to latex products in the current workplace, and evaluate the need for work restrictions.

Sensitive people suffering from contact dermatitis should be advised to wash, rinse, and dry hands thoroughly before putting on gloves. They should select gloves, if available, that are low in chemical additives. Workers determined to be latex-sensitive should prevent or minimize their exposure through the following measures:

• skin manifestations — flushing, itching, hives;

• bronchospasm — cough, wheezing;

• cardiovascular events — hypotension, tachycardia, vasoconstriction;

• upper airway obstruction — stridor, hoarseness.

Type IV reactions are delayed and are cell-mediated and localized to the area of contact. Sensitized cells produce inflammation or contact dermatitis resulting in local itching, swelling, or rash.