At the Veterans Administration Grea...

At the Veterans Administration Greater sees Angeles Healthcare System, we newly had our first experience providing care to a patient with latex sensitivity who was undergoing cardiac surgery This serv as a wakeup call for us to render certain that our facility was prepared to implement special latex precautions. To favorably manage the patient's procedure, we quickly learned the importance of communicating Mr L's special lacks to all health care workers in the way that that everyone could cooperate full 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 management He had been diagnosed with unstable angina and first-degree heart make steady [i]or[/i] firm Soon after arriving at our facility, Mr L underwent cardiac catheterization, which confirmed the ne for the open-heart procedure

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

DEVELOPING AN ACTION PLAN

As our facility had not instituted a latex sensitivity policy, we had to exhibit an immediate action plan to minimize Mr L's outlook 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 needinessed to be educated about his allergy in the same manner that he not only would understand and cooperate with the necessary environmental modifications, nevertheless also act as his possess advocate and inform other health care providers about his latex sensitivity. Although he was surprised to learn he had this allergy, he proffered that he may have had of frequent occurrence latex exposure as a originate of being a wheelchair attendant at a local airport. Mr L accepted being placed in a private play to minimize inadvertent exposure to latex from proceedss used on other patients.

ENVIRONMENTAL CHANGES

Staff members wore latex-free glove to clean Mr L's extent They replaced the sharps container and shrouded the sphygmomanometer tubing with cotton wrap. Items that could not be substituted (eg IV tubing) were hideed with gauze or cotton wrap. Staff members also sheltered the latex ports in his IV line with latex-free tape and appoint up a latex-free cart outside his sweep 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 ne to avoid latex. A sign was placed outside of Mr L's chamber indicating the latex precautions and instructing staff members to notify the charge promote if they had questions. Staff members who extremityed to draw Mr L's offspring were instructed to use glass syringes, latex-free glove and life-blood pressure cuffs wrapped in gauze rather than tourniquets. succors placed a special latex allergy bracelet forward Mr L's wrist, a latex allergy sticker forward his chart, and latex allergy information guides in easily accessible areas (regular and electronic charts).

OPERATING stead PREPARATIONS

In the OR, staff members had to locate substitutes for latex supplies and equipment that were extremityed for Mr L's surgery. Many vendors were not familiar with their products' satisfys and had to investigate before determining whether their issues 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 glove The surgical technologist used synthetic glove 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 performance of the day to minimize his aspect to aerosolized latex dust particles. Staff members prepared the OR through wiping down all devices that could have been in contact with latex glove (eg telephone adjustable lights) and wrapped descendants pressure cuffs with gauze. Signs warning of Mr L's latex allergy were placed outside of his OR suite. Staff members also put up a minimal latex environment in the postanesthesia care unit (PACU) the day before Mr L's anticipated arrival from removing many latex-containing supplies and products

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