DuraPrep use in pt with mild iodine allergy

[coleeliza]

Hi all. I have been a nurse for almost a year and a half now. I am 5 months New to the OR. Currently I am training in spine surgery (fusions, microdiscs and such). Recently I have been on my own circulating. I seem to continue to work with the same surgeon, who always prefers the use of DuraPrep before surgery. In this particular instance today, I had a patient with multiple allergies. Multiple antibiotics with a reaction of "itching". Therefore, was not able to put bacitracin irrigation on the field. I seem to have overlooked that one of her allergies was "iodinated topical solutions." I guess I did not realize, or look to see that DuraPrep does in fact have 0.7% iodine in the prep solution. I proceeded with prepping the surgical site with DuraPrep, per surgeon preference. We then did a time out while waiting for the solution to dry. I named off the patients allergies, where it was then brought up that the patient did in fact have an allergy to iodine and that DuraPrep had iodine in it. I made it aware that the patient had a mild reaction that included itching in the past (says this in the chart). I apologized and offered to use prep remover at the end of the case, which the surgeon agreed to. I am wondering if this prep remover does much good in alleviating skin irritation to DuraPrep/iodine? Or does it just remove the color stain? Kind of freaking out. Does anyone have experience or knowledge with the 3M DuraPrep remover? Any insight would help. Thanks!

[Rose_Queen, BSN, MSN, RN]

I always verify with my patient whenever an iodine allergy is listed in the chart. Depending on the surgeon, there are times they will request a spot check with topical iodine prior to moving into the OR. One surgeon is fond of saying that no one can be allergic to iodine- it's an element and is part of the human body. Heck, table salt is iodized. And itching with no rash? May not even really be an allergy at all. I get itchy from certain prep solutions, but that's because of the skin drying that the alcohol can cause. I'd never list it an an allergy. Some people will list an allergy for everything, no matter how unrelated or minor the effect.

Did you fill out an incident report? Follow up with your educators? We actually have a list posted in every OR that tells us what supplies/solutions/preps/meds contain iodine for quick reference.

No experience with the prep remover- we always leave ours in place since they are effective after the patient leaves the OR.

[MunoRN, RN]

While it's possible to be allergic or to have an intolerance to Povidone, it's not possible to have a true allergy to iodine. Iodine is intentionally unavoidable, if you could somehow avoid it you'd have a giant goiter on your neck and/or be dead. It's also not a type of molecule capable of triggering an allergic reaction. So typically when people say they are allergic to topical iodine, they are referring to the common preparation which is povidone-iodine. I don't believe duraprep contains povidone, so there's not a particularly clear reason not to use it.