Perioperative anaphylactic reactions to central venous and pulmonary artery catheters containing chlorhexidine, sulfadiazine, or latex: a historical cohort study

• Published in: Canadian journal of anesthesia 2023-05, Vol.70 (5), p.824-835
• Main Authors: Pinnock, Terrique M., Volcheck, Gerald W., Smith, Mark M., Murray, Andrew W., Renew, Johnathan R., Smith, Bradford B.
• Format: Article
• Language: English
• Subjects: Adult; Anaphylaxis; Anaphylaxis - chemically induced; Anaphylaxis - epidemiology; Anesthesiology; Cardiology; Catheterization, Central Venous; Catheters; Central Venous Catheters; Chlorhexidine - adverse effects; Cohort analysis; Cohort Studies; Critical Care Medicine; Humans; Intensive; Latex allergies; Latex Hypersensitivity - epidemiology; Medicine; Medicine & Public Health; Pain Medicine; Pediatrics; Pneumology/Respiratory System; Pulmonary arteries; Pulmonary Artery; Reports of Original Investigations; Retrospective Studies; Silver Sulfadiazine; Sulfadiazine
• ISSN: 0832-610X; 1496-8975
• DOI: 10.1007/s12630-023-02403-8

Purpose Central venous catheters (CVCs) and pulmonary artery catheters (PACs) containing chlorhexidine, silver sulfadiazine, or latex can cause perioperative anaphylaxis. We examined the incidence of and outcomes associated with anaphylaxis caused by CVCs/PACs. Methods In a historical cohort study, we retrospectively identified adult patients fitted with CVCs/PACs at the Mayo Clinics in Minnesota, Arizona, and Florida from 1 January 2008 to 1 March 2018. Potential and confirmed cases of perioperative anaphylactic reactions were individually reviewed and classified. Results During the study period, 39,505 procedures were performed during which CVCs/PACs were inserted. Of these, 2,937 patients with pre-existing chlorhexidine, sulfonamide (sulfa), and/or latex allergies had CVCs/PACs inserted that contained these substances. Perioperative anaphylaxis, in which CVCs/PACs were the confirmed or potential causative agent, occurred during 53 procedures. Seven patients had a preoperatively reported sulfa or latex allergy; no patients had a preoperative chlorhexidine allergy. Six of the seven patients with reported allergies to sulfa or latex had a CVC/PAC inserted that contained these substances. Twenty-four patients with anaphylaxis had postoperative allergic disease consultation; ten of these (42%) underwent skin testing. Conclusion Perioperative anaphylactic reactions related to CVCs/PACs containing chlorhexidine, silver sulfadiazine, or latex were rare in this large historical cohort study. We identified 2,937 patients with pre-existing chlorhexidine, sulfa, and/or latex allergies and had CVCs/PACs inserted that contained these substances. Although few cases of perioperative anaphylaxis attributable to these substances were observed in patients with corresponding allergies, the potential for substantial complication exists. Providers should be aware of the potential for these hidden exposures.