The rise in incidence of latex allergy may be attributed not only to increased use of latex products in patient care but also to the manner in which raw latex was collected and aged. Allergic reactions are caused by latex proteins retained in the finished products, which can show great variations in latex allergen levels. The greatest environmental hazard exposure is produced by latex gloves and the powder from the gloves that becomes airborne.
The U.S. Food and Drug Administration (FDA) now requires that all medical devices containing natural rubber latex that may directly or indirectly contact the patient display the following statement: “Caution: This product contains natural rubber latex which may cause allergic reactions.”
Increased or continued exposure increases sensitivity to latex allergens and worsens allergic reactions. Patients and healthcare providers can become sensitized to latex through repeated skin or mucous membrane contact or by inhaling aerosolized glove allergens.
Latex allergy often begins with a rash on the hands (from gloves).
Strategies and protocols include the following:
Identify allergic patients (those with a history of problems related to catheters, tubes, drains, household items, condoms, latex gloves, balloons, toys, and so on); allergy testing (see Chapter 8) may be desirable. Communicate and document data appropriately.
Never wear powdered latex gloves when caring for a sensitized patient.
Avoid contact of latex with tissue (e.g., wounds, mucous membranes, vaginal skin). Practice proper hand hygiene.
Use latex-free products. Examples include the following:
Gloves
Endotracheal tubes
Suction and wound drainage tubes and reservoir systems
Catheters
Blood pressure cuffs
Stethoscopes
Temperature probe covers, tape, dressings, ACE wraps
Monitoring equipment and supplies (leads, pulse oximeter probes, and cables)
Remove rubber stoppers from vials before withdrawing or reconstituting contents. Rinse syringes with sterile water or saline before use.
Remove latex ports from IV tubing and replace with stopcocks or nonlatex plugs. Tape ports shut if no other alternative is available. Replace ports on IV therapy bags with nonlatex ports.
Keep resuscitation equipment and emergency supplies and medications readily accessible at all times in the event that anaphylaxis occurs. (Caution: Some resuscitation supplies and equipment may contain latex.)
Instruct the patient about latex-containing supplies, both medical and nonmedical, that could pose problems (Chart 1.4).
Stay current in knowing which products contain latex. The Spina Bifida Association of America routinely publishes updated lists of latex-containing products (see www.spinabifidaassociation.org).
Assembling and maintaining a cart with latex-free supplies and equipment may be desirable to facilitate safe patient care.
Clinical Alert
Sensitive persons should carry autoinjectable epinephrine (e.g., EpiPen), nonlatex gloves, and emergency medical instructions; should wear a medical alert bracelet; should avoid all forms of latex; and should alert healthcare providers, family, friends, and employers of the diagnosis and need to avoid latex.
Clinical Alert
If latex-free blood pressure cuffs and stethoscopes are not available, shield the patient’s arm with stockinette and apply the cuff over it. Small-diameter (finger-sized) stockinette can be used to cover stethoscope tubing, leads, and so on.
Clinical Alert
Symptoms of anaphylaxis include a dangerous drop in blood pressure, dyspnea, flushed facial appearance, swelling (of throat, tongue, and nose), a feeling of impending doom, and loss of consciousness.
Clinical Alert
Airway maintenance
Administration of oxygen
Volume expansion (IV lactated Ringer or normal saline solution)
Epinephrine IV
Steroids (orally or IV)
Diphenhydramine (orally or IV)