Re: Anaphylaxsis

[Lori Lucia]

In my case the patient did not have any allergies known at the time.  She was a mother of a small child, relatively healthy otherwise and had never had anything like this before.  

 

Lori Lucia, CRNI

IV Nurse Consultant

IV ASSIST

San Francisco Bay Area

Darilyn Cole <[EMAIL PROTECTED]> wrote:

Could this have been a latex allergy?  My radiologist just told me of an incident that happened to him recently with a vein ablation.  The patient failed to mention her latex allergy and no sooner had he placed the sheath (which had been touched by his sterile latex gloves ) she went anaphylactic.  It was very serious.

 

Darilyn Cole, CRNI


Lynn Hadaway <[EMAIL PROTECTED]> wrote:

This patient probably experienced mast cell activation syndrome (aka idiopathic anaphylaxis or an anaphylactoid reaction) which is not the same pathophysiology as a true IgE-mediated allergic reaction. I have seen it and been quite involved with this for many years since my experiences with Menlo Care and the old Landmark midline catheter. At that time, we thought this is what was happening with the reported reactions from the Landmark insertion but we did not ever get to perform causality studies to prove it. This has subsequently been reported in the literature with other brands of midlines and PICCs. I would venture to say that the patient is probably not allergic to anything used in the procedure. This is a mechanical stimulation of the mast cells, the cousin of the basophil, and located very close to veins and nerves in the tissue. They are usually as prevalent as 10,000 mast cells per cubic millilmeter, so lots of them to be stimulated. They immediately release histamine and cause what looks like an alergic reaction. Your patient should be referred to an allergist for a complete workup to rule out what they may or may not actually be allergic to. This could impact their future healthcare if labelled as allergic to something that is not accurate. There really is no good way to diagnose mast cell activation syndrome without working with an allergist to rule out possible true allergies. Mast cell stimulation is part of basic anatomy and physiology and you can learn more about this in the A&P chapter in the INS textbook.

Finally, I would **not** remove the catheter because you may need to give some IV medications and without a good IV line this may prove difficult. The mechanical trauma of insertion probably caused this reaction so once it is placed the insult is over. Taking it out does not remove the cause as the presence of the catheter material is not the offending agent. I would also assess patients allergies before placing a PICC because a patient that is atopic, or one with many known allergies, is at risk for this reaction. By the way, red man syndrome from Vancomycin is a chemical stimulation of these same mast cells, so it is related but neither are true allergic reactions.  Lynn

At 7:42 AM -0500 4/12/06, Erickson, Wendy wrote:

An interesting anecdote for you PICC nurses!  My newest most insecure PICC nurse had quite a weekend.  She placed a PICC in a patient, using MST and ultrasound, and everything went smoothly.  She had the dressing on and had flushed with Heparin and was just beginning to clean up the sterile field and the patient said she felt funny in the head.  They put her head back thinking she was feeling faint.  Then the patient said she needed a bucket, she was going to throw up, which she did.  Then she said she couldn't breathe!  And then she lit up like a Christmas tree with hives from head to toe!  They called for help and the PICC nurse, scared to death, pulled the PICC out.  The patient was treated with benadryl and O2 and was monitored closely, her symptoms resolved and she got through it ok.  The physician indicated it was an allergic reaction to something - heparin, lidocaine, the PICC material itself (polyurethane), who knows..  The chart was marked with both the heparin and lido allergy.

My poor nurse had the poop scared out of her - as I think we all would have had!  This, of course, was a lady that the PICC nurse had to work hard at convincing the patient and her son of the benefits of a PICC line!  Anyone ever see this happen?  Anything suggestions other than to not place a PICC in this lady ever again?

Wendy Erickson RN
PICC Service Coordinator
Luther Hospital - Mayo Health System
Eau Claire WI

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Lynn Hadaway, M.Ed., RNC, CRNI
Lynn Hadaway Associates, Inc.
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