Latex Allergy - page 2

I had my first latex case this past Friday. Pt needed a foley so I went and pulled latex free cath and separate bag with KY and other supplies. Later on my charge nurse pulled me to the side and ask... Read More

  1. by   core0
    Quote from crackerjack
    We have the same policy in place for latex allergic patients in our OR however, unfortunately, if a patient says she/he is allergic to latex we have to treat it as such even if the sx symply indicate latex sensitivity. I appreciate the fact that it may be only a sensitivity but the fact that our patients are coming in for surgery places them at a distinct disadvantage healthwise. They are ill in some way and we are causing a major assault to the body which could result in the body reacting to latex proteins more extremely than in the past. Better to treat this like a 'pain is what the patient says it is' situation. It's kind of a sore spot at my hospital as we have several surgeons and anesthesiologists who wish to dismiss it altogether at times. It's extra work then there's the wait time to TC the room and set it up again when we failed to get the information at scheduling that the patient is latex allergic and find out the day of surgery. ugh what a nightmare!
    The policies around here are different. They either need a documented airway problem - preferably by anesthesia or a positive latex IgA rast. Othewise No ticket no ride. The cost of doing all these "latex" cases was just prohibitive. I have done more than 200 rast tests in the last three years for latex allergy and only one of them has been a true allergy.

    David Carpenter, PA-C
  2. by   crackerjack
    Quote from core0
    The policies around here are different. They either need a documented airway problem - preferably by anesthesia or a positive latex IgA rast. Othewise No ticket no ride. The cost of doing all these "latex" cases was just prohibitive. I have done more than 200 rast tests in the last three years for latex allergy and only one of them has been a true allergy.

    David Carpenter, PA-C
    We are to the point where almost everything we use is latex free anyway. The only changes we have to make are the bag on the anesthesia vent and to move it to first of the day, and latex free gloves for the surgical team. Our rooms are TC'd every night...or at least that's what our night orderly is supposed to be doing! Other changes would simply involve avoiding a few common items such as a penrose or using a latex free foley.

    I'm surprised it is so cost prohibitive over non-latex allergy cases for your institution as most manufacturers and suppliers are moving to make their products latex-free.

    As an aside, we had a patient recently who was a DO no less and was in for her second total knee. She and her PhD husband were very *needy* to say the least. They both insisted that she was allergic to the drain used on her previous total and were adamant that we NOT use that kind again. It was a standard silicone drain. I've never heard of anyone being allergic to silicone but hey, anything can happen. However, this woman also wore a CPAP nightly and brings it with her for PACU. The mask is silicone. Somehow the DO couldn't tell the difference in an allergic reaction and standard surgical site inflammation and irritation. Go figure.

    Have a good day!
  3. by   GA,RNC
    I have a latex allergy and am scared to death of your supervisor's statement. Latex particles are deadly to some latex allergic people (they are to me!). My advice: keep yourself out of any litigation and keep your conscience clear and continue to use latex free supplies/equipment!
  4. by   scrubnurse
    Kleinbbc~
    I just had this same thing happen! I have worked in the OR for 13 yrs, but new to L&D. In the OR, when we have a latex allergy, it is a major ordeal...
    Change out this, can't use this, etc...
    Well on L&D, I had my first latex allergy pt. I asked my preceptor what precautions to take besides the obvious. After going in the supply room, I discover they have silicone catheters, but no seperate urinebags/urinemeters. So I take the catheter out and ask where to find a urinebag to attach to the catheter. She says, "oh we just use the regular one. Just take the latex catheter off and put the new one on."
    I was flabbergasted! I was just glad my pt never needed a foley. Now I am wondering how to handle this in the future. I don't feel comfortable doing that. Any thoughts???
  5. by   Marie_LPN, RN
    Quote from scrubnurse
    Kleinbbc~
    I just had this same thing happen! I have worked in the OR for 13 yrs, but new to L&D. In the OR, when we have a latex allergy, it is a major ordeal...
    Change out this, can't use this, etc...
    Well on L&D, I had my first latex allergy pt. I asked my preceptor what precautions to take besides the obvious. After going in the supply room, I discover they have silicone catheters, but no seperate urinebags/urinemeters. So I take the catheter out and ask where to find a urinebag to attach to the catheter. She says, "oh we just use the regular one. Just take the latex catheter off and put the new one on."
    I was flabbergasted! I was just glad my pt never needed a foley. Now I am wondering how to handle this in the future. I don't feel comfortable doing that. Any thoughts???

    In a pinch, call the OR and ask for a separate Foley bag.

    And i'd push for separate bags until we got them stocked.
  6. by   scrubnurse
    Marie,
    Forgot to mention I am also new to this hospital, and it is way bigger than where I used to work. I don't even know where the OR is at this hospital, so I can't call them and request a foley. They would think I was crazy.
    Being new is the hard part. I hate to be that new person who comes in and makes waves, challenging current ways of doing things, but on the other hand, if I feel it is unsafe for my pt, I will not do it. I guess I will address this with the charge nurse.
  7. by   DDRN4me
    Quote from core0
    The real question should be was this a real latex allergy. There are lots of people that have a "latex allergy" but it is really a latex sensitivity. I work in GI and if we have a real latex allergy case we have a standard protocol. Has to be done in the OR (not GI lab) has to be the first case of the day. Room has to be terminated the night before (complete scrub down). All latex material has to be removed before terminating the room and any cabinets with latex material have to be sealed.

    As you can see this is a real pain and has led to a dramatic reduction in latex cases. Ask yourself a few questions. Is there airway involvement, can they wear regular underwear (elastic contains latex) etc. Most people have a latex sensitivity and you just need to avoid direct contact with latex. The ones that truely have a latex allergy give you a definite appreciation for the amount of latex in the hospital environment.

    David Carpenter, PA-C
    I would never take that chance with someones life!!!! as we all know, a "latex sensitivity " could turn into full blown anaphalaxis in seconds...sorry i value my patients life and my license way too much to take that chance.
  8. by   Marie_LPN, RN
    I don't even know where the OR is at this hospital, so I can't call them and request a foley. They would think I was crazy.

    Whether they'd think you're crazy or not is their problem not yours.

    We never give any other depts. any grief for calling and requesting stuff. We don't get grief if we request stuff from another floor. Because it's being done for the pt. If people can't understand that, then they're in the wrong line of work.
  9. by   crackerjack
    Quote from Marie_LPN
    Whether they'd think you're crazy or not is their problem not yours.

    We never give any other depts. any grief for calling and requesting stuff. We don't get grief if we request stuff from another floor. Because it's being done for the pt. If people can't understand that, then they're in the wrong line of work.
    :yeahthat: just today i had a floor nurse call and request a non-latex foley from our OR. It is not an unusual request. However, the way she requested it was a bit *special*. She never could quite come up with what she wanted, only kept telling me it was a 'clear' one, not like the rest. I finally asked if she meant a non-latex foley and she was much relieved LOL

    But seriously, call the OR and ask for one. The way we do things is to have the floor person come pick it up and bring a patient sticker with them so we can handle charges for the item(s). Your hospital may do things a bit differently, just ask. This gal didn't know where our OR was either, just a few quick directions and she was on her way.
  10. by   lostfromlatex
    You absolutely did the right thing! Your charge nurse was wrong. Using a foley kit containing a latex catheter attached to the bag, means everything in that kit has been exposed to latex. If the patient has a severe latex allergy, you are putting that patient at risk using the kit and exchanging the catheter. Your charge nurse needs to be re-educated on this subject matter.
  11. by   BeeSunnyRN
    OMG!! I hope to high heaven I am never in the facility that David PA-C is working in.

    In the past I have not repsonded to a latex Ig-A rast (I was told there are many who do not respond to the test), thankfully all my docs have taken me seriously enough not to provoke a true airway emergency just to be able to 'document' the veracity of my allergy.

    However, I do very silently have a decreased BP, O2 sat, and LOC when exposed to latex that is in my vicinity. Note - that is not contact and therefore really has very little to do with my underwear having any elastic.

    Please have the compassion to believe a patient who says they are latex allergic or sensitive - I'm not sure exactly what the difference is any way - the level of the previous mild reaction versus the next reaction which could be life-threatening?

    Not to mention that this protection could save you from a lawsuit which is probably a lot more expensive than the cost to take precautions.
  12. by   core0
    Quote from beesunnyrn
    omg!! i hope to high heaven i am never in the facility that david pa-c is working in.

    in the past i have not repsonded to a latex ig-a rast (i was told there are many who do not respond to the test), thankfully all my docs have taken me seriously enough not to provoke a true airway emergency just to be able to 'document' the veracity of my allergy.

    first of all, i don't make the rules, the hospitals do. they are based on evidence medicine. i would not agree that there are many that do not respond to an iga rast. there are people with selective iga deficency, but this is relatively rate with a rate of 1:400-2000. it is more common in people with autimmune diseases.

    however, i do very silently have a decreased bp, o2 sat, and loc when exposed to latex that is in my vicinity. note - that is not contact and therefore really has very little to do with my underwear having any elastic.

    please have the compassion to believe a patient who says they are latex allergic or sensitive - i'm not sure exactly what the difference is any way - the level of the previous mild reaction versus the next reaction which could be life-threatening?

    not to mention that this protection could save you from a lawsuit which is probably a lot more expensive than the cost to take precautions.
    documented airway reaction is one indication for latex precautions. not sure what you mean by silenty decreased o2 sat but this sounds like an anaphylactic reaction. in that case i would schedule it as a latex case. the reason that we ask about elastic is that its principal component is latex. patients that have a anaphylactic reaction to latex are counseled that they should not wear garments that contain latex. this is all part of the history that we gather to determine whether a patient needs to be on latex precautions or not.

    practicing careful evidence based medicine with a good history and a good understanding of the patient is the way to avoid lawsuits (and practice good medicine).

    david carpenter, pa-c
  13. by   Gidgette_gj
    [font=book antiqua]so i too have had "contact dermatitis" and have recently began reacting to the the elastic on the iso gowns that we have at work. i had an appt last week with the allergist and my rast was negative!
    [font=book antiqua]so from experience/knowledge can some one tell me how concerned
    i should be with this?
    [font=book antiqua]i think my problem is mostly denial, but am not getting over that any time soon, so i thought i would try talking about it!
    [font=book antiqua]i do have local reactions to certain foods...bananas and nuts....for instance.
    [font=book antiqua]also after hours at work i do have occassional chest tightness -wheezing though. and doe.
    [font=book antiqua]any thoughts, or words of support would be appreciated.
    [font=book antiqua]should i be getting a medical alert bracelet?
    [font=book antiqua]i am so frustrated over this!
    [font=book antiqua]thanks for listening!!
    [font=book antiqua]gidgette_gj rn

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