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Quantifying exposure to chlorhexidine from decontamination of peripheral intravenous injection ports
Background Annually, almost 2 billion peripheral intravenous cannulas (PIVCs) are placed worldwide. In response to concerns of infectious complications, chlorhexidine is increasingly utilised for maintenance decontamination of PIVC injection ports. Concomitantly, the allergenic potential of chlorhex...
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| Published in: | Acta anaesthesiologica Scandinavica 2023-03, Vol.67 (3), p.356-363 |
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| container_title | Acta anaesthesiologica Scandinavica |
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| creator | Doane, Matthew A. Kwong, Christopher Proschogo, Nicholas |
| description | Background
Annually, almost 2 billion peripheral intravenous cannulas (PIVCs) are placed worldwide. In response to concerns of infectious complications, chlorhexidine is increasingly utilised for maintenance decontamination of PIVC injection ports. Concomitantly, the allergenic potential of chlorhexidine exposures has been highlighted by several case reports, implicating it as a trigger when used for this seemingly innocuous process. Given how widespread this application is, elucidating potential chlorhexidine exposure is needed to gauge its risks and benefits.
Objective
To examine and quantify if chlorhexidine is entrained when used for PIVC injection port cleaning.
Methods
Twenty benchtop PIVC set‐ups were cleaned with 2% chlorhexidine and 70% alcohol wipes, following three different pragmatic protocols. Each set‐up was injected with 10 ml ultrapure water, and samples tested by liquid chromatography‐electrospray tandem mass spectrometry for entrained chlorhexidine.
Results
Chlorhexidine was detected in every sample. Mean concentrations and standard deviations from each protocol were 41.47 ppb (4.08), 54.76 ppb (17.46), and 65.84 ppb (7.01). One‐way ANOVA indicated a statistical difference between at least two groups (df = 2, F = 24.11, p |
| doi_str_mv | 10.1111/aas.14189 |
| format | article |
| fullrecord | <record><control><sourceid>proquest_cross</sourceid><recordid>TN_cdi_proquest_miscellaneous_2757054328</recordid><sourceformat>XML</sourceformat><sourcesystem>PC</sourcesystem><sourcerecordid>2776883404</sourcerecordid><originalsourceid>FETCH-LOGICAL-c3489-e1c4f37280f4f958e3e0ac5134053c58b84119cc9683f49e39c88e4c5fe0d9343</originalsourceid><addsrcrecordid>eNp1kE1LxDAQhoMoun4c_ANS8KKHukmTtMlxEb9AEFHPJaYTN0ub1KRV998b3dWD4FxmBh6eGV6EDgk-I6mmSsUzwoiQG2hCqJR5yatyE00wxiTnpCp20G6Mi7RSJuU22qElZ1VBiwlq7kflBmuW1r1k8NH7OAbIBp_peevDHD5sYx1kJvgua0B7N6jOOjVY7zJvsh6C7ecQVJtZNwT1Bs6PMc0L0N9M78MQ99GWUW2Eg3XfQ0-XF4_n1_nt3dXN-ew215QJmQPRzNCqENgwI7kAClhpTijDnGoungUjRGotS0ENk0ClFgKY5gZwIymje-hk5e2Dfx0hDnVno4a2VQ7SW3VR8QpzRguR0OM_6MKPwaXvElWVQqSjX8LTFaWDjzGAqftgOxWWNcH1V_R1ir7-jj6xR2vj-NxB80v-ZJ2A6Qp4ty0s_zfVs9nDSvkJdG2Obg</addsrcrecordid><sourcetype>Aggregation Database</sourcetype><iscdi>true</iscdi><recordtype>article</recordtype><pqid>2776883404</pqid></control><display><type>article</type><title>Quantifying exposure to chlorhexidine from decontamination of peripheral intravenous injection ports</title><source>Wiley</source><creator>Doane, Matthew A. ; Kwong, Christopher ; Proschogo, Nicholas</creator><creatorcontrib>Doane, Matthew A. ; Kwong, Christopher ; Proschogo, Nicholas</creatorcontrib><description>Background
Annually, almost 2 billion peripheral intravenous cannulas (PIVCs) are placed worldwide. In response to concerns of infectious complications, chlorhexidine is increasingly utilised for maintenance decontamination of PIVC injection ports. Concomitantly, the allergenic potential of chlorhexidine exposures has been highlighted by several case reports, implicating it as a trigger when used for this seemingly innocuous process. Given how widespread this application is, elucidating potential chlorhexidine exposure is needed to gauge its risks and benefits.
Objective
To examine and quantify if chlorhexidine is entrained when used for PIVC injection port cleaning.
Methods
Twenty benchtop PIVC set‐ups were cleaned with 2% chlorhexidine and 70% alcohol wipes, following three different pragmatic protocols. Each set‐up was injected with 10 ml ultrapure water, and samples tested by liquid chromatography‐electrospray tandem mass spectrometry for entrained chlorhexidine.
Results
Chlorhexidine was detected in every sample. Mean concentrations and standard deviations from each protocol were 41.47 ppb (4.08), 54.76 ppb (17.46), and 65.84 ppb (7.01). One‐way ANOVA indicated a statistical difference between at least two groups (df = 2, F = 24.11, p < .00001), with Tukey's testing verifying significantly different mean concentrations between all groups (p < .01).
Conclusions
Using 2% chlorhexidine and 70% alcohol swabs to decontaminate PIVC injection ports resulted in consistent entrainment of chlorhexidine, with varying amounts correlated to how it was applied. These results validate case reports attributing anaphylactic/allergic reactions to suspected intravenous chlorhexidine entrainment and should factor into future risk–benefit assessments for its use in PIVC maintenance antisepsis policies and protocols.</description><identifier>ISSN: 0001-5172</identifier><identifier>EISSN: 1399-6576</identifier><identifier>DOI: 10.1111/aas.14189</identifier><identifier>PMID: 36547232</identifier><language>eng</language><publisher>England: Wiley Subscription Services, Inc</publisher><subject>Allergic reactions ; allergy ; Anaphylaxis ; Case reports ; Catheterization ; Catheterization, Peripheral ; Chlorhexidine ; chlorhexidine alcohol wipes ; chlorhexidine entrainment ; chlorhexidine injection ; Cleaning ; Complications ; Decontamination ; Decontamination - methods ; Entrainment ; Ethanol ; Exposure ; Humans ; Hypersensitivity ; immunology ; Injection ; injection port ; Injections, Intravenous ; Intravenous administration ; intravenous cannula ; Liquid chromatography ; Maintenance ; Mass spectrometry ; Mass spectroscopy ; Mean ; needleless hub ; Risk factors ; Variance analysis</subject><ispartof>Acta anaesthesiologica Scandinavica, 2023-03, Vol.67 (3), p.356-363</ispartof><rights>2022 The Authors. published by John Wiley & Sons Ltd on behalf of Acta Anaesthesiologica Scandinavica Foundation.</rights><rights>2022 The Authors. Acta Anaesthesiologica Scandinavica published by John Wiley & Sons Ltd on behalf of Acta Anaesthesiologica Scandinavica Foundation.</rights><rights>2022. This article is published under http://creativecommons.org/licenses/by/4.0/ (the “License”). Notwithstanding the ProQuest Terms and Conditions, you may use this content in accordance with the terms of the License.</rights><lds50>peer_reviewed</lds50><oa>free_for_read</oa><woscitedreferencessubscribed>false</woscitedreferencessubscribed><cites>FETCH-LOGICAL-c3489-e1c4f37280f4f958e3e0ac5134053c58b84119cc9683f49e39c88e4c5fe0d9343</cites><orcidid>0000-0002-1620-9613</orcidid></display><links><openurl>$$Topenurl_article</openurl><openurlfulltext>$$Topenurlfull_article</openurlfulltext><thumbnail>$$Tsyndetics_thumb_exl</thumbnail><link.rule.ids>314,780,784,27924,27925</link.rule.ids><backlink>$$Uhttps://www.ncbi.nlm.nih.gov/pubmed/36547232$$D View this record in MEDLINE/PubMed$$Hfree_for_read</backlink></links><search><creatorcontrib>Doane, Matthew A.</creatorcontrib><creatorcontrib>Kwong, Christopher</creatorcontrib><creatorcontrib>Proschogo, Nicholas</creatorcontrib><title>Quantifying exposure to chlorhexidine from decontamination of peripheral intravenous injection ports</title><title>Acta anaesthesiologica Scandinavica</title><addtitle>Acta Anaesthesiol Scand</addtitle><description>Background
Annually, almost 2 billion peripheral intravenous cannulas (PIVCs) are placed worldwide. In response to concerns of infectious complications, chlorhexidine is increasingly utilised for maintenance decontamination of PIVC injection ports. Concomitantly, the allergenic potential of chlorhexidine exposures has been highlighted by several case reports, implicating it as a trigger when used for this seemingly innocuous process. Given how widespread this application is, elucidating potential chlorhexidine exposure is needed to gauge its risks and benefits.
Objective
To examine and quantify if chlorhexidine is entrained when used for PIVC injection port cleaning.
Methods
Twenty benchtop PIVC set‐ups were cleaned with 2% chlorhexidine and 70% alcohol wipes, following three different pragmatic protocols. Each set‐up was injected with 10 ml ultrapure water, and samples tested by liquid chromatography‐electrospray tandem mass spectrometry for entrained chlorhexidine.
Results
Chlorhexidine was detected in every sample. Mean concentrations and standard deviations from each protocol were 41.47 ppb (4.08), 54.76 ppb (17.46), and 65.84 ppb (7.01). One‐way ANOVA indicated a statistical difference between at least two groups (df = 2, F = 24.11, p < .00001), with Tukey's testing verifying significantly different mean concentrations between all groups (p < .01).
Conclusions
Using 2% chlorhexidine and 70% alcohol swabs to decontaminate PIVC injection ports resulted in consistent entrainment of chlorhexidine, with varying amounts correlated to how it was applied. These results validate case reports attributing anaphylactic/allergic reactions to suspected intravenous chlorhexidine entrainment and should factor into future risk–benefit assessments for its use in PIVC maintenance antisepsis policies and protocols.</description><subject>Allergic reactions</subject><subject>allergy</subject><subject>Anaphylaxis</subject><subject>Case reports</subject><subject>Catheterization</subject><subject>Catheterization, Peripheral</subject><subject>Chlorhexidine</subject><subject>chlorhexidine alcohol wipes</subject><subject>chlorhexidine entrainment</subject><subject>chlorhexidine injection</subject><subject>Cleaning</subject><subject>Complications</subject><subject>Decontamination</subject><subject>Decontamination - methods</subject><subject>Entrainment</subject><subject>Ethanol</subject><subject>Exposure</subject><subject>Humans</subject><subject>Hypersensitivity</subject><subject>immunology</subject><subject>Injection</subject><subject>injection port</subject><subject>Injections, Intravenous</subject><subject>Intravenous administration</subject><subject>intravenous cannula</subject><subject>Liquid chromatography</subject><subject>Maintenance</subject><subject>Mass spectrometry</subject><subject>Mass spectroscopy</subject><subject>Mean</subject><subject>needleless hub</subject><subject>Risk factors</subject><subject>Variance analysis</subject><issn>0001-5172</issn><issn>1399-6576</issn><fulltext>true</fulltext><rsrctype>article</rsrctype><creationdate>2023</creationdate><recordtype>article</recordtype><sourceid>24P</sourceid><recordid>eNp1kE1LxDAQhoMoun4c_ANS8KKHukmTtMlxEb9AEFHPJaYTN0ub1KRV998b3dWD4FxmBh6eGV6EDgk-I6mmSsUzwoiQG2hCqJR5yatyE00wxiTnpCp20G6Mi7RSJuU22qElZ1VBiwlq7kflBmuW1r1k8NH7OAbIBp_peevDHD5sYx1kJvgua0B7N6jOOjVY7zJvsh6C7ecQVJtZNwT1Bs6PMc0L0N9M78MQ99GWUW2Eg3XfQ0-XF4_n1_nt3dXN-ew215QJmQPRzNCqENgwI7kAClhpTijDnGoungUjRGotS0ENk0ClFgKY5gZwIymje-hk5e2Dfx0hDnVno4a2VQ7SW3VR8QpzRguR0OM_6MKPwaXvElWVQqSjX8LTFaWDjzGAqftgOxWWNcH1V_R1ir7-jj6xR2vj-NxB80v-ZJ2A6Qp4ty0s_zfVs9nDSvkJdG2Obg</recordid><startdate>202303</startdate><enddate>202303</enddate><creator>Doane, Matthew A.</creator><creator>Kwong, Christopher</creator><creator>Proschogo, Nicholas</creator><general>Wiley Subscription Services, Inc</general><scope>24P</scope><scope>WIN</scope><scope>CGR</scope><scope>CUY</scope><scope>CVF</scope><scope>ECM</scope><scope>EIF</scope><scope>NPM</scope><scope>AAYXX</scope><scope>CITATION</scope><scope>7T5</scope><scope>7TK</scope><scope>H94</scope><scope>7X8</scope><orcidid>https://orcid.org/0000-0002-1620-9613</orcidid></search><sort><creationdate>202303</creationdate><title>Quantifying exposure to chlorhexidine from decontamination of peripheral intravenous injection ports</title><author>Doane, Matthew A. ; Kwong, Christopher ; Proschogo, Nicholas</author></sort><facets><frbrtype>5</frbrtype><frbrgroupid>cdi_FETCH-LOGICAL-c3489-e1c4f37280f4f958e3e0ac5134053c58b84119cc9683f49e39c88e4c5fe0d9343</frbrgroupid><rsrctype>articles</rsrctype><prefilter>articles</prefilter><language>eng</language><creationdate>2023</creationdate><topic>Allergic reactions</topic><topic>allergy</topic><topic>Anaphylaxis</topic><topic>Case reports</topic><topic>Catheterization</topic><topic>Catheterization, Peripheral</topic><topic>Chlorhexidine</topic><topic>chlorhexidine alcohol wipes</topic><topic>chlorhexidine entrainment</topic><topic>chlorhexidine injection</topic><topic>Cleaning</topic><topic>Complications</topic><topic>Decontamination</topic><topic>Decontamination - methods</topic><topic>Entrainment</topic><topic>Ethanol</topic><topic>Exposure</topic><topic>Humans</topic><topic>Hypersensitivity</topic><topic>immunology</topic><topic>Injection</topic><topic>injection port</topic><topic>Injections, Intravenous</topic><topic>Intravenous administration</topic><topic>intravenous cannula</topic><topic>Liquid chromatography</topic><topic>Maintenance</topic><topic>Mass spectrometry</topic><topic>Mass spectroscopy</topic><topic>Mean</topic><topic>needleless hub</topic><topic>Risk factors</topic><topic>Variance analysis</topic><toplevel>peer_reviewed</toplevel><toplevel>online_resources</toplevel><creatorcontrib>Doane, Matthew A.</creatorcontrib><creatorcontrib>Kwong, Christopher</creatorcontrib><creatorcontrib>Proschogo, Nicholas</creatorcontrib><collection>Open Access: Wiley-Blackwell Open Access Journals</collection><collection>Wiley-Blackwell Open Access Backfiles</collection><collection>Medline</collection><collection>MEDLINE</collection><collection>MEDLINE (Ovid)</collection><collection>MEDLINE</collection><collection>MEDLINE</collection><collection>PubMed</collection><collection>CrossRef</collection><collection>Immunology Abstracts</collection><collection>Neurosciences Abstracts</collection><collection>AIDS and Cancer Research Abstracts</collection><collection>MEDLINE - Academic</collection><jtitle>Acta anaesthesiologica Scandinavica</jtitle></facets><delivery><delcategory>Remote Search Resource</delcategory><fulltext>fulltext</fulltext></delivery><addata><au>Doane, Matthew A.</au><au>Kwong, Christopher</au><au>Proschogo, Nicholas</au><format>journal</format><genre>article</genre><ristype>JOUR</ristype><atitle>Quantifying exposure to chlorhexidine from decontamination of peripheral intravenous injection ports</atitle><jtitle>Acta anaesthesiologica Scandinavica</jtitle><addtitle>Acta Anaesthesiol Scand</addtitle><date>2023-03</date><risdate>2023</risdate><volume>67</volume><issue>3</issue><spage>356</spage><epage>363</epage><pages>356-363</pages><issn>0001-5172</issn><eissn>1399-6576</eissn><abstract>Background
Annually, almost 2 billion peripheral intravenous cannulas (PIVCs) are placed worldwide. In response to concerns of infectious complications, chlorhexidine is increasingly utilised for maintenance decontamination of PIVC injection ports. Concomitantly, the allergenic potential of chlorhexidine exposures has been highlighted by several case reports, implicating it as a trigger when used for this seemingly innocuous process. Given how widespread this application is, elucidating potential chlorhexidine exposure is needed to gauge its risks and benefits.
Objective
To examine and quantify if chlorhexidine is entrained when used for PIVC injection port cleaning.
Methods
Twenty benchtop PIVC set‐ups were cleaned with 2% chlorhexidine and 70% alcohol wipes, following three different pragmatic protocols. Each set‐up was injected with 10 ml ultrapure water, and samples tested by liquid chromatography‐electrospray tandem mass spectrometry for entrained chlorhexidine.
Results
Chlorhexidine was detected in every sample. Mean concentrations and standard deviations from each protocol were 41.47 ppb (4.08), 54.76 ppb (17.46), and 65.84 ppb (7.01). One‐way ANOVA indicated a statistical difference between at least two groups (df = 2, F = 24.11, p < .00001), with Tukey's testing verifying significantly different mean concentrations between all groups (p < .01).
Conclusions
Using 2% chlorhexidine and 70% alcohol swabs to decontaminate PIVC injection ports resulted in consistent entrainment of chlorhexidine, with varying amounts correlated to how it was applied. These results validate case reports attributing anaphylactic/allergic reactions to suspected intravenous chlorhexidine entrainment and should factor into future risk–benefit assessments for its use in PIVC maintenance antisepsis policies and protocols.</abstract><cop>England</cop><pub>Wiley Subscription Services, Inc</pub><pmid>36547232</pmid><doi>10.1111/aas.14189</doi><tpages>8</tpages><orcidid>https://orcid.org/0000-0002-1620-9613</orcidid><oa>free_for_read</oa></addata></record> |
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| ispartof | Acta anaesthesiologica Scandinavica, 2023-03, Vol.67 (3), p.356-363 |
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| subjects | Allergic reactions allergy Anaphylaxis Case reports Catheterization Catheterization, Peripheral Chlorhexidine chlorhexidine alcohol wipes chlorhexidine entrainment chlorhexidine injection Cleaning Complications Decontamination Decontamination - methods Entrainment Ethanol Exposure Humans Hypersensitivity immunology Injection injection port Injections, Intravenous Intravenous administration intravenous cannula Liquid chromatography Maintenance Mass spectrometry Mass spectroscopy Mean needleless hub Risk factors Variance analysis |
| title | Quantifying exposure to chlorhexidine from decontamination of peripheral intravenous injection ports |
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