Latex-free central venous lines

Abstract

We would like to alert the anaesthetic community to a potential problem with central lines in patients with latex allergy. Recently, a 17-year-old girl presented to the casualty of our hospital with stridor. She had a history of allergies to multiple agents including latex. Intravenous epinephrine and crystalloids were administered. She rapidly developed cyanosis, hypotension and pulmonary oedema. She was intubated and transferred to the intensive care unit. Central venous access was needed for monitoring and drug infusions. As part of the latex allergy protocol, we have a trolley that contains latex-free equipment, an equipment database and relevant references. In one of the references, Dakin and Yentis [1] provide a list of latex-free equipment, which includes the Arrow triple-lumen catheter, which is the favoured catheter in our hospital. However, when M.P. was getting ready to insert the central line (Arrow triple-lumen catheter product no CS-15703-E) he noticed that there was a warning in the package insert that said that the product contained natural rubber. The catheter was not inserted. Personal communications with Arrow International confirmed that the injection caps from the catheter extension lines contained latex and the product could be made latex-free after removing the injection caps. It has been shown that an allergic reaction can take place with only one part per billion exposure [2]. There remains the possibility of latex contamination of the catheter despite removal of the injection caps. Arrow International have also confirmed that they are in the process of converting to latex-free all their central line products.