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Source To Surgery - February 1995, Vol. 3 Issue I
Latex Precautions in the Operating Theater
Linda L. Gearing, RN, MS, Division of Allergy/lmmunology, Medical
College of Wisconsin, Milwaukee, Wisconsin, U.S.A.
Kevin J. Kelly, MD
A stepwise approach in the hospital and peri-operative setting to care
for the latex sensitive patient is necessary. At the Children's Hospital
of Wisconsin, USA, a multidisciplinary task force was established to
develop a policy and procedure for the detection, care and education of
the latex sensitive patient. Manufacturers of all equipment used in the
hospital were contacted using a standard letter requesting details of
the content of latex protein in each product. A database of all latex
and non-latex products was developed. This list is upgraded every three
months and distributed to each department to allow staff access to
non-latex devices. Review of glove usage and purchasing of low-allergen
gloves is included in the evaluation of products used.
Latex Allergy Precautions
The primary principle in management of allergy is to avoid the offending
antigen by limiting environmental contact with products that contain the
allergen. Communication, documentation and coordination of all personnel
are essential to avoid a potential problem through inadvertent contact
with latex allergen. This task is often assumed by the nurse who
coordinates the activity and movement of patients through the
peri-operative period.
Guidelines for ancillary departments that have contact with latex
sensitive patients need to be developed. Each department should devise
an educational plan to familiarize the staff with latex allergies and
precautions.
Interdisciplinary quality assessment system should be established
to review all suspected reactions to natural rubber latex and to monitor
the effectiveness of latex avoidance procedures.
Patients with suspected latex sensitization are referred to their
physician for evaluation. Patients who have developed systemic symptoms
or anaphylaxis should always carry emergency injectable adrenaline
medication.
Following precautionary guidelines that are tailored to the
individual needs of an institution will protect latex sensitive patients
from possible untoward reactions.
| Nursing responsibility in the care of the latex sensitive patient |
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- Assess patient for latex sensitivity
- Identify with an allergy bracelet patients allergic to latex
- Notify anaesthesia personnel so that appropriate equipment can be gathered and pre-surgical prophylaxis (if necessary) can be initiated
- Remove all latex gloves from the patient's room and immediate holding area
- Ensure that all personnel in contact with the patient are aware of the latex precaution and what can be done
- Obtain the list of non-latex alternatives and prepare ahead for the patient's needs
- Schedule the patient as the first case of the day
- Mark the patient's theater trolley and the theater doors for latex allergy
- Avoid contact with all latex products during peri-operative care:
- use synthetic examination gloves in the patient's room
- prepare the extremity that will be used to monitor blood pressure with a cotta dressing to minimize exposure to the latex tubing
- use a stopcock rather than rubber ports to administer intravenous medication
- remove rubber stoppers used to draw up medications
- use non-latex catheter equipment
- The scrub nurse should maintain a latex-free environment throughout the procedure
- Communication with the post anesthesia staff prior to the patient's arrival is essential to maintain the latex-free environment
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However, it is virtually impossible to avoid exposure to latex protein
completely, as adequate substitute materials may not be available and
the ubiquitous presence of rubber products derived from latex is
unavoidable.
| Basic Steps In The Development Of Latex Allergy Guidelines |
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- Form a multidisciplinary latex allergy committee that includes staff from all
disciplines (e.g., medicine, surgery, anaesthesia, allergy, nursing, hospital
administration, pharmacy, central sterilization processing, central supply,
employee health, quality assessment)
- Develop a uniform policy to handle the latex sensitive patient in the
preoperative, operative and post-anaesthesia care areas
- Develop standard questions to be asked of all patients, which are aimed at
detecting undiagnosed or confirmed latex allergy
- Obtain details of the latex content of all products used in the operating
theater (and hospital) in writing from manufacturers or distributors;
set up a uniform system to update and disseminate this information on a
scheduled basis
- Develop latex-free emergency equipment
- Develop educational materials for staff and patients
- Monitor the quality of the procedure for handling latex sensitive patients and
establish a review process for all suspected reactions
- Educate personnel about the personal risks of latex allergy
- Make recommendations for the purchase of low-allergen latex gloves to minimize
exposure of the health care professional and patient to allergen
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Further Reading
Buback ME, Reed CE, Fransway AF et al. Allergic reactions to
latex among health care workers. Mayo Chin Proc 1992; 67:
1075-9.
Sussman G. Mario S. Dolovich J The spectrum of IgE-mediated responses to
latex. JAMA 1991; 265: 2844-7.
Turjanmaa K. Incidence of immediate allergy to latex gloves in hospital
personnel. Contact Dermatitis 1987; 17: 270-5.
Young MA, Meyers M, McCulloch LD, Brown LJ. Latex allergy, a guideline
for peri-operative nurses. AORN Journal 1992; 56: 488-502.
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