Latex products in the hospital environment A u t h o r : D e b r a Adkins , RN, Tor r ing ton , C o n n e c t i c u t

p lease note: These lists are offered as a guideline to

individuals, families, and professionals. It is very

difficult to obtain full and accura te information on the

latex content of products, wh ich may vary b e t w e e n

companies and product series. Double-checking with

suppliers before use with latex-allergic individuals is

strongly recommended . The information in this list is

constantly chang ing as manufacturers improve their

product and more is learned about latex allergy. The

lists were last upda ted in January 1997. See pages 136-

138 for a list of medica l devices that frequently contain

latex and their latex-safe alternatives.

R e f e r e n c e s

Greet Labs, Inc. Allergic cross reactivity of latex and foods [technical bulletin]. June 1996. MeeropoI E, Leger R, Frost J. Latex allergy patients with myelodysplasia and in the health care providers: a double jeopardy. J Urol Nuts 1993:13:39-44. Meeropol E, Romanczuk A. Spina Bifida Association of America; (800) 261-3141. Shapiro E, Kelly K J, Setlock MA, Suwalski KL, Meyers P. Complications of latex allergy: dialogues in pediatric urology. 1992;15:1-8. Young MA, Meyers M, McCulloch LD, Brown LJ. Latex allergy: a guide]me for perioperative nurses. AORN J 1992:56: 488-502.

R e p r i n t e d w i t h p e r m i s s i o n f r o m L a t e x Allergy News, 176 R o o s e v e l t Ave., Torrington, CT 06790; phone (860) 482-6869.

Table 1 Latex a l l e r g y a n d c r o s s - r e a c t i v i t y w i t h food a n d i n h a l a n t s

D e g r e e of a s s o c i a t i o n or p r e v a l e n c e

H i g h M o d e r a t e L o w or u n d e t e r m i n e d

B a n a n a A v o c a d o C h e s t n u t

A p p l e Pear Grass Carrot P e a c h Ragweed Celery Cherry Mugwort Papaya Pineapple Hazelnut Kiwi Strawberry Walnut Potato Fig Soybean Tomato Grape P e a n u t M e l o n Apr icot Plum

P a s s i o n fruit N e c t a r i n e Rye Mango Wheat

Allergies to la tex a n d mu l t ip l e fruits or v e g e t a b l e s h a v e b e e n recen t ly d o c u m e n t e d to p r o d u c e p a t t e r n s of allergenic cross-reactivity. Although the details of t h e clinical relationship b e t w e e n la tex a n d food allergies await further study, food a l lerg ies h a v e b e e n f o u n d to co ex i s t with latex s en s i t i v i t i e s for s o m e people . There m a y be cross -react iv i ty b e t w e e n la tex a l lerg ies a n d t h e food and i n h a l a n t s listed.

Debra Adkins is founder and editor of Latex Allergy News'. For reprints, write Debra Adkins, RN, 176 Roosevelt Ave., Torrington, CT 06790. J Emerg Nurs 1997;23:135-8. 18 /9 /80474

April 1997 1 3 5

JOURNAL OF EMERGENCY NURSING/Adkins

Frequent ly conta in latex

Airway, masks, and straps

Ambu Bag

Anesthesia, bags and ventilator circuits

Band-Aids

Bed protector (washable rubber) Bite block Blood pressure cuff, tubing

Bulb syringes

Buretrols (have latex diaphragm) Casts: Delta-Lfte Comfortable

Catheters, leg bags, drainage systems

Catheters, rectal pressure

Catheters, condom

Catheters, indwelling

Catheters, urodynamics Catheters, straight, coude Chux (washable underpads) Colostomy pouch Dental dams

Dental: gutta percha " : -c L

Dental: anesthetic

Dental: hygiene, cleaning and home care Dental: orthodontic supplies

Drains--Rubber Dressings--Moleskin, Dynaflex (Johnson & Johnson), Action Wrap, Colban (3M), BDF Elastoplast

Examples of latex-safe al ternatives /barriers

Hudson (Temecula, Calif., [800] 848-3766), Vital Signs (Totawa, N.J., [800] 932-0760) airways and mask, Polamedco Airways (Inglewood, Calif., [310] 417-3901) Silicone: PMR 2 (Puritan-Bennett, Carlsbad, Calif., [310] 417- 3901), SPUR (Ambu, Hanover, Mass.), Vital Blue, Respironics (Murryville, Pa., [800] 345-6443), Laerdal (Armonk, N.Y., [800] 431-1055), Armstrong Medical (Lincolnshire, ]]1., [847] 913-0101) Neoprene bag (Anesthesia Associates, San Marcos, Calif., [619] 744-6561), Ohmeda adult (Madison, Wis., [800] 345- 2700) well-washed systems Active Strips (3M; latex in packaging; St. Paul, Minn., [612] 733-1110), Readi-Bandages, sterile dressing with plastic tape Disposable underpads

Use over clothing, Webril or stoctdnette, Cleen Cuff (Vital Signs), Dinamap (Critikon, Tampa, Fla., [813] 887-2000), PerfecCBalance (PyMaH Corp., Flemington, N.J. [800] 526-3538) PVC (Davol, Jamestown, R.I., [401] 423-3030), Medline (Rusch, Duluth, Ga.) B. Braun Burettes (Bethlehem, Pa., [800] 258-9000) (Johnson & Johnson) Scotchcast soft cast, Delta-Lite S, fiberglass, fabric (Johnson & Johnson, Piscataway, N.J., [800] 942-7764), Caraglas Ultra Velcro nylon straps, PVC (Mentor, Santa Barbara, Calif., [800] 235-5731), Dale (Bard Systems, Bi]lerica, Mass., [800] 225-0927) Lifetech (Houston, Tex., [713] 495-9411), Cook (Bloomington, Ind., [800] 593-2080) Clear advantage (Mentor), Silicone (Coloplast, Tampa, Fla., [813] 886-5634), Rochester (Tampa, Fla., [800] 328-5544), Rusch Vitaid Pro-Sys, NL (Convatec) Silicone (KendeJJ, Mansfield, Mass., [800] 962-9888), (Argyle, St. Louis, Mo., [314] 635-2211), (Bard, Rochester, Rusch, Vitaid) Bard, Rusch, Cook, Lffetech Mentor, Coloplast, RobNel (Sherwood, St. Louis, Mo.), Bard Disposable underpads

Nonlatex dams (The Hygenic Corp., Akron, Ohio [800] 321- 2135) ESPE-Premier Ketac Endo (gloss ionomer, Norristown, Pa., [800] 344-8295) Sensorcaine (bupivicaine), xylocaine, lidocaine glass ampules (Wyeth, St. Davids, Pa. [800] 999-9384) John O. Butler Co., Chicago ([800] 228-4890) Latex-free bands (Midwest Ozthodontic Mfg., Columbus, Iowa [800] 448-5594)

Duoderm (Squibb, Atlanta, Ga., [404] 349-4000), Reston foam (3M), Comfeel, Venigard, Opsite (Coloplast), Xerofoam (Sherwood, St. Louis, Mo., [800] 325-7472), Pin Care (Hollister, Libertyville, Ill., [708] 680-1000), Bioclusive, Montgomery straps (Johnson and Johnson), Webril

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Adkins/JOURNAL OF EMERGENCY NURSING

Frequently contain latex Examples of latex-safe alternatives/barriers

Elastic wrap: ACE wraps, Esmarch, Zimmer, Elastil<on

Electrode bulbs, pads, grounding

Endotracheal tubes, airways

Enema, ready to use (Fleet-latex valve)

Fluid circulating warming blankets G-tubes, buttons Gastroscopy tubes Gloves, sterile, clean and surgical

(Kendall), Metalline, Seloper, Opraflex (Lohmann) NOTE: Steri-Strips, Active Strips, Flexible fabric adhesive band, Tegaderm, Tegasorb (3M) contain latex in packaging only CoNco all-cotton elastic bandage, Adban Adhesive Elastic Bandage, X-Mark (Avcor, Ft. Worth, Tex., [817] 551-0595), Comprilan (Jobst), San Francisco, Calif. [415] 612-0440], Esmark (De Royal, Powe]l, Tenn. [800] 251-4864) Baxter (Overland Park, Kan., [913] 491-1111), Conmend (Utica, N.Y., [315] 797-8375), Vermont Med (Bellows Falls, Vt.), Va]leylab (Boulder, Colo., [800] 255-8522), Dantec EMG (Campbell, Calif., [800] 835-9873) Mallinckrodt (Harrisburg, Pa., [800] 368-5416), Sheridan, Porte)< (Keene, N.H., [603] 352-8921), Shlley, Berman (Boston, Mass., [617] 737-7855), Rusch, Polemedco (Stylett, [310] 577-1422) Glycerin, Baby Lax (Fleet, Lynchburg, Va., [804] 528-4000), Theravac, Bowel Management Tube (MIC), cone irrigation set (Convatec) Cover and keep away from patient skin Silicone (MIC, Bard, Stomate, Rusch)

IV reed pumps Injection ports, Y-sites, bags, buretrol ports, PRN adapters, and needleless systems

Medication vial stoppers

Nasogastric tube OR masks, hats, shoe covers

Orthopedic appliances Oxford tubes Oxygen masks, cannulas Peak flow meters Penrose drain

Pulse oximeters

Vinyl, neoprene, polymers gloves: Neolon, Sensicare, Tru- touch (Maxxim, Clearwater, Fla., [800] 727-7340), Tactyl 1,2 (SmartPractice, Phoenix, Ariz., [800] 822-8956), Dermaprene (Eatontown, N.J., [800] 327-8659), Allergard (Johnson & Johnson), Duraprene Triflex (Baxter), Elastryn (Hermal, Delmar, N.X, [800] 437-6251) N-DEX (Best, [800] 241-0323), Pure Advantage (7~Jioston, Bedford, N.H., [603] 472-6660) Do not use; cassettes have rubber Cover Y-sites, and do not use. Use stopcock for medications. Flush IV tubing before use. Polymer injection caps (Braun, Bethlehem, Pa. [800] 828-0793), Abbott nitroglycerin hibing (Abbott Park, ]]]., [708] 937-6100), Walrus Gemini (IMED, San Diego, Calif., [800] 854-2033), some Baxter systems, Baxter Buretrols, Braun Burettes, SAFES1TE (Braun), Clave (ICU Medical, IrvJne, Calif., [714] 753-1599), Abbott needleless systems Eli-Lilly (Indianapolis, Ind., [317] 276-2000), Fujisawa (Deerfield, Ill. [800] 317-8800); if not certain, remove latex stopper

Kimberly-Clark, Roswe]i, Ga. ([800] 524-3577); otherwise replace elastic bands with twill tape. PFR 95 Particulate Filter Respirators (Tecnol, Ft. Worth, Tex., [800] 832-6651)

Remove elastic bands, check valve content Peak Flow Meters, Healthscan, Cedar Grove, ]]1. ([800] 902-1266) Jackson Pratt, silicone tubing, Zimmer Hemovac (Lakewood, Colo., [303] 980-8858) Certain oxisensor (Ne]]cor, Pleasanton, Calif., [510] 463-4000), cover digit with Opsite

April 1997 137

JOURNAL OF EMERGENCY NURSING/Adkins

F r e q u e n t l y c o n t a i n l a t e x E x a m p l e s o f l a t e x - s a f e a l t e r n a t i v e s / b a r r i e r s

Protective sheets Respirators-tb (3M 9970)

Rubber reflex hammer Rubber head straps (OR) Spacer (for metered-dose inhalers)

Stethoscope tubing

Suction catheters

Surgical gowns, boots, drapes Syringes, disposable, autoinjectable

Tape, adhesive, porous, pink Waterproof (3M)

Teeth protectors Theraband, Therastrips, Theratubes Tourniquet

Tubing, sheeting

Tympanonometer-rubber Ureteral stints Vascular stockings (Jobst) Ventilator hose, balloons, bellow Waterproof mattress covers, beds, OR tables stretchers

and

Advantage (MSA, Pittsburgh, Pa.), Hepa-tech (Uvex Safety, Shafer, Minn. [612] 257-3600) Cover with plastic bag

ACE spacer (Center Laboratories, Port Washington, N.Y. [800] 223-6837) PVC (Armstrong, Lincolnshire, I]1.), cover stockinette, or ScopeCoat, Manchester, N.H. ([800] 373-0747) PVC (Mallinckrodt, Harrisburg, Pa. [800] 368-5416) Yankauer (Davol, Covington, Ga. [800] 526-4455) Superior, Laerdal, Medline, Ballard Kimberly-Clark ([800]-524-3577) Prepare medication in syringe right before use, or in a glass syringe. Baxa (feeding syringes), Abboject, Abbott PCA, Terurno syringes, Norrn-ject (Air-Tite; [800] 231-7762); Epi- Pen (Center Labs), certain 1 ml, 60 ml, and reusable glass syringes (Becton-Dickinson) Microfoam, Micropore, Durapore, Transpore (3M), Dermaclear, Dermicel, Waterproof (Johnson & Johnson), Scanpore (Hermal), Mastisol liquid adhesives

Cover with cloth, exercise putty (Roylan) Grafco, Children's Med Ventures, ([800] 377-3449), VelcroPedic, X-Tourn strap (Avcor), or place over clothing or stockinette, or cover with cloth Plastic tubing, Tygon LR-40 (Norton), elastic thread, sheets (JPS Elastomerics, Parker, Colo., [303] 790-8700)

Compriform Custom (Jobst, San Francisco [415] 621-0440)

Cover with sheets and avoid any contact with patient skin

"u u

Thumbs Up T h u m b s up to NBC's top-rated te lev i s ion s h o w ER for spot l ight ing the i s sues of unsafe f loating of nurses , and the demoral izat ion and threa tened rep lacement of senior staff nurses . While the portrayal is not perfect, it is a sympathet ic , w e l c o m e d airing of the problem.

138 Volume 23, Number 2