Open heart surgery and the latex-sensitive patient - Statistical Data Included

AORN Journal, July, 2000 by Elissa Cerone, Joan Brosnan, Claire H. Pelletier

At the Veterans Administration Greater Los Angeles Healthcare System, we recently had our first experience providing care to a patient with latex sensitivity who was undergoing cardiac surgery. This served as a wakeup call for us to ensure that our facility was prepared to implement special latex precautions. To successfully manage the patient's procedure, we quickly learned the importance of communicating Mr L's special needs to all health care workers so that everyone could cooperate fully in his preoperative and postoperative treatment.

CASE STUDY

Mr L, a 59-year-old retired white male, was transferred to our facility as a candidate for a cardiac bypass graft procedure. He had been diagnosed with unstable angina and first-degree heart block. Soon after arriving at our facility, Mr L underwent cardiac catheterization, which confirmed the need for the open-heart procedure.

Mr L's transfer chart indicated he had no allergies; however, he reported he suffered from chronic skin rashes that he treated with fluocinonide cream. The day after being admitted, Mr L developed inflamed purulent plaques surrounding his heparin lock, which the dermatologist indicated had the classic appearance of atopic dermatitis. The dermatologist determined that the plaques could be either a result of Mr L's anxiety about his upcoming procedure or the development of a latex allergy. A patch test confirmed that Mr L was having a reaction to latex, and his history indicated that his rashes were increasing in severity. Staff members were concerned that Mr L's rashes caused the atopic dermatitis and could trigger a more systemic reaction if he continued to be exposed to latex.

DEVELOPING AN ACTION PLAN

As our facility had not instituted a latex sensitivity policy, we had to develop an immediate action plan to minimize Mr L's exposure to latex. We reviewed literature and contacted colleagues at other health care facilities for their input. Our plan included patient education, environmental changes, staff member education and communication, and OR preparation.

PATIENT EDUCATION

Mr L needed to be educated about his allergy so that he not only would understand and cooperate with the necessary environmental modifications, but also act as his own advocate and inform other health care providers about his latex sensitivity. Although he was surprised to learn he had this allergy, he volunteered that he may have had frequent latex exposure as a result of being a wheelchair attendant at a local airport. Mr L accepted being placed in a private room to minimize inadvertent exposure to latex from products used on other patients.

ENVIRONMENTAL CHANGES

Staff members wore latex-free gloves to clean Mr L's room. They replaced the sharps container and covered the sphygmomanometer tubing with cotton wrap. Items that could not be substituted (eg, IV tubing) were covered with gauze or cotton wrap. Staff members also covered the latex ports in his IV line with latex-free tape and set up a latex-free cart outside his room that accompanied him throughout his hospital stay.

STAFF EDUCATION AND COMMUNICATION

All hospital staff members who might have contact with Mr L had to be informed about his need to avoid latex. A sign was placed outside of Mr L's room indicating the latex precautions and instructing staff members to notify the charge nurse if they had questions. Staff members who needed to draw Mr L's blood were instructed to use glass syringes, latex-free gloves, and blood pressure cuffs wrapped in gauze rather than tourniquets. Nurses placed a special latex allergy bracelet on Mr L's wrist, a latex allergy sticker on his chart, and latex allergy information guides in easily accessible areas (regular and electronic charts).

OPERATING ROOM PREPARATIONS

In the OR, staff members had to locate substitutes for latex supplies and equipment that were needed for Mr L's surgery. Many vendors were not familiar with their products' contents and had to investigate before determining whether their products contained latex. All equipment to be used for Mr L had to be extensively rinsed, as glutaraldehyde solutions previously used to clean equipment could be contaminated from contact with latex gloves. The surgical technologist used synthetic gloves to prepare instrument trays and avoided using tape that could contain latex. Equipment to be used for Mr L was sterilized separately.

Mr L's surgery was scheduled as the first procedure of the day to minimize his exposure to aerosolized latex dust particles. Staff members prepared the OR by wiping down all devices that could have been in contact with latex gloves (eg, telephones, adjustable lights) and wrapped blood pressure cuffs with gauze. Signs warning of Mr L's latex allergy were placed outside of his OR suite. Staff members also set up a minimal latex environment in the postanesthesia care unit (PACU) the day before Mr L's anticipated arrival by removing many latex-containing supplies and products.

As many items in the OR contain latex, staff members had to examine the contents of oxygen masks, drains, x-ray equipment, surgical tape, suture material, laryngoscope light bulb gaskets, endotracheal tubes, airways, bronchoscopes, stethoscopes, catheters, and dressings and clean equipment using latex-free gloves. Staff members had to replace the elastic on Mr L's oxygen mask with twill tape and could not use a nasal airway. Staff members also had to ensure that the urinary catheter used for Mr L was 100% silicone, rather than silicone and latex, and that stopcocks were used for drawing blood. Latex-free gloves were set aside for placing Mr L's hemodynamic line.