LATEX ALLERGY PATIENT PROTOCOL OBJECTIVE: To identify patients who are at risk or have a latex allergy and provide nursing care guidelines for management of latex sensitive/allergic patients. SUPPORTIVE DATA: Latex sensitivity can be limited to a contact dermatitis (T- cell mediated) or result in a true anaphylactic reaction that is IgE mediated. Multiple latex exposures in a susceptible individual triggers the production of IgE antibodies to a protein constituent of latex. Upon re-exposure, the allergen binds to these IgE antibodies, triggering the release of multiple mediators from the mast cell (including histamine, leukotrienes, heparin and seratonin.) Mediator release results in extreme vasodilation, tachycardia, bronchospasm, and coronary vasoconstriction. This reaction can be triggered and propagated to a fatal outcome by very small amounts of allergen. Hypersensitivity responses to latex may be either local or systemic. The reaction can occur even with trivial exposure to latex and may result in cardiorespiratory arrest within minutes. Latex anaphylaxsis can occur from absorption through disrupted skin, inhalation, and contact with mucous membranes. Skin exposure often causes urticaria. Communication between health care workers is essential to properly care for the patient with a latex allergy. 1.) Identify latex sensitive/allergic patients on admission to the hospital in any department as either an outpatient or an inpatient. A.) Ask specifically if they are allergic to latex when questioning regarding allergies. B.) A patient that has multiple allergies, unexplained anaphylaxsis during surgery or a medical procedure, or has had frequent surgeries as a child is at increased risk for being latex sensitive. Testing is indicated if the patient shows possible latex sensitivity. Refer to admitting physician for final determination. 2.) Latex Allergy Precautions will be used with all patients identified as allergic to latex and those patients considered high risk. A.) Place latex allergy sign on patient door and above patient's bed.. B.) Place latex allergy bracelet on patient. C.) The nurse will protect the patient from unintended exposure. Pt contact with any latex product must be avoided. D.) Allergy to latex will be clearly marked on the outside of the chart and appropriately documented in the nursing notes and nursing care plan. E.) Notify the OR as soon as possible if a latex sensitive patient is scheduled for surgery. F.) A latex safe cart will be obtained from C.S. and kept with the patient while in the hospital. G.) Pharmacy must be notified. All prescriptions sent to pharmacy should be stamped latex allergy. H.) Radiology, lab, etc. are notified if this patient is required to have procedures performed in these areas. I.) Check with M.D. re: anaphylaxsis medication at the bedside. J.) In addition to substitution of items, the following measures will be implemented to protect the patient from latex allergens: a.) Nonlatex glove should be used as a tourniquet. If this is too small, the patient's extremity must be covered with rolled cotton, kling or kerlix. b.) Protect the patient's arm with above if no latex free BP cuff is available. Cover stethoscope tubing with stockinette. c.) Remove rubber stopper from med vials before withdrawing medications. d.) Use latex free syringes to mix and/or administer medications. e. )Use IV tubing with latex ports covered to prevent injection. It is preferable to use latex free IV tubing if available. f.) Read all premixed meds to determine if there is latex present. Some IM/IV solutions of diphenhydramine (Benadryl) contain latex. g.) Armboards should be covered with kerlix prior to use. h.) Dressings are to be secured with plastic tape. i.) Rinse all gas sterilized products. Ethylene Oxide sterilization has been associated with latex allergies. j.) Wash hands and face and change outer garment after using latex gloves, before entering room of latex allergic patient. k.) Whenever possible, schedule patient for first procedure of the day in any department. 3.) Allergic Reactions and Treatment A.) Onset and Symptoms of Allergic Reactions To Latex Type 1: Contact Urticaria Type 1: Anaphylaxsis Type 4: Contact dermatitis ONSET felt immediately extremely variable appears in 12-24 hrs. progresses in 15-20 ranges 5-290 peaks in 48 hrs. resolves spont over 1-2 hrs. (typically 30 ) resolves 72-96 hrs. CLINICAL SIGNS immediate, localized stinging,or discomfort urticaria, pruritis, pruritis, cutaneous over exposed area flushing over exposed Redness and inflammation followed by redness, areas vesicle and blister swelling, wheal diaphoresis GI reaction and flare formation nausea, vomiting, diarrhea cramping may progress to anaphylaxsis CV hypotension with tachycardia and arrhythmias Respiratory bronchospasm, wheezing, laryngeal edema Other facial and peripheral edema, feeling of faintness, feeling of impending doom *Most common causes of death are laryngeal edema and cardiovascular collapse B.) Treatment a.) stop treatment or procedure and remove irritation agent if possible b.) maintain airway with 100% O2 c.) immediate emergency therapy should be initiated for an allergic reaction d.) follow protocol for airway management, CPR, and code 99 e.) medical interventions *epinephrine is the treatment of choice *anticipate the physician ordering bronchodilators, IV histamine blockers and steroids *start intravascular volume expansion for hypotension 4.) Discharge and Follow-up Recommendations A.) Patient should wear an allergy identification bracelet at all times (Medic-Alert). B.) Personnel at labs, dentist etc. should be informed of allergy prior to appointment so that latex safe supplies and equipment can be available. C.) Patient should check with their physician re: carrying an auto injector epinephrine syringe. D.) Suggest patient carry non-latex gloves with them. E.) Give list of information resources to patient and family. 5.) Report incident of adverse reaction to latex to the Food and Drug Administration Problem Reporting Program @ 1-800-638-67 6.) Planning for a Latex Allergic Procedure in the Operating Room A.) Should be the first case of the day. B.) Remove all latex items. C.) Determine from the surgeons preference card all items containing latex. D.) Collaborate with central supply and purchasing departments for obtaining latex free products. E.) Check surgical attire for elastic. a.) wear surgical hoods instead of bonnets b.) use masks with strings c.) wear designated shoes without shoe covers F.) Remove all supplies that would not be used for the case. G.) Terminally clean and seal room after latex items removed. H.) Change filters in the positive pressure air system. I.) Replace the OR bed mattress with eggcrate and secure to bed. J.) Ensure that supplies and instruments were sterilized in a latex free load. The supplies are then placed in the prepared OR. 7.) Post anesthesia A.) Isolate or recover the patient in the OR or patient's room. B.) Check for latex in the oxygen mask, suction, catheters, nasogastric tubes and medications. 8.) Post op care A.) Determine that room equipment is latex free. B.) Respiratory therapy should provide a latex free ambu bag, oxygen mask and supplies. C.) Dietary services:do not enter the patient's room wearing hair bonnet with elastic band. D.) Laboratory:do not use latex tourniquet,bandaids or carry tray of supplies into room. 9.) C.S.will set up and maintain a latex safe cart. Contents will include but not be limited to: A.) latex allergy sign for posting on the room's door B.) non latex exam gloves C.) non latex sterile gloves D.) silastic catheters, straight and foley E.) plastic stopcocks F.) plastic tape G.) webril and stockinette H.) non latex ambu bag I.) latex free syringes 10.) Latex Allergy Resources Latex free products for home and community Alternate Resource Catalog (708) 503-8298 NO Latex Industries (800) 296-9185 Reliable Express (888) 225-1941 ELASTIC- Education of Latex Allergy/Support Team and Information Coalition Idaho Representative: Jacqueline Freudenthal (208) 234-1015 national- (610) 436-4801 Latex Allergy Information Service Debra Adkins (860) 482-6869 American College of Allergy, Asthma and Immunology 85 West Algonquin Road, Suite 550 Arlington Heights, Illinois 60005 (847) 427-1200 Spina Bifida Association of America (800) 621-3141 FDA Latex Allergy Hotline (301)594-3060 ALERT- The Allergy to Latex Education and Resource Team based at the Asthma/Allergy Center in Milwaukee Support Group (414) 677-9707