Life-threatening chlorhexidine anaphylaxis caused by skin preparation before chlorhexidine-free central venous catheter insertion: a case report and literature review.
Anaphylaxis
Chlorhexidine
Skin preparation
Journal
Journal of anesthesia
ISSN: 1438-8359
Titre abrégé: J Anesth
Pays: Japan
ID NLM: 8905667
Informations de publication
Date de publication:
06 2023
06 2023
Historique:
received:
23
02
2023
accepted:
29
03
2023
medline:
1
6
2023
pubmed:
30
4
2023
entrez:
29
4
2023
Statut:
ppublish
Résumé
Chlorhexidine is a common cause of perioperative anaphylaxis, and global regulatory authorities have issued warnings about anaphylaxis due to chlorhexidine-containing central venous catheters (CVC) and its mucosal absorption. We present a case of life-threatening anaphylaxis after CVC insertion caused by chlorhexidine used for skin preparation. The onset of anaphylaxis was rapid and very severe, resulting in pulseless electrical activity. The patient was successfully resuscitated by emergency veno-arterial extracorporeal membrane oxygenation (VA-ECMO). Our case suggests that even skin preparation before chlorhexidine-free CVC insertion can cause life-threatening anaphylaxis. We reviewed the literature on chlorhexidine anaphylaxis cases and categorized all potential routes of chlorhexidine exposure to assess the risk following skin preparation. Our results showed that skin preparation before CVC insertion was the third most common cause of chlorhexidine anaphylaxis after transurethral exposure and chlorhexidine-containing CVCs. However, skin preparation with chlorhexidine before CVC insertion was sometimes overlooked as a cause of chlorhexidine anaphylaxis, and its risk might be underestimated. Further, no previous reports have described life-threatening anaphylaxis solely due to chlorhexidine skin preparation before CVC insertion. CVC insertion might cause the chlorhexidine used for skin preparation to reach the vascular system and should be recognized as a potential cause of life-threatening chlorhexidine anaphylaxis.
Identifiants
pubmed: 37120585
doi: 10.1007/s00540-023-03189-1
pii: 10.1007/s00540-023-03189-1
doi:
Substances chimiques
Chlorhexidine
R4KO0DY52L
Types de publication
Review
Case Reports
Journal Article
Research Support, Non-U.S. Gov't
Langues
eng
Sous-ensembles de citation
IM
Pagination
474-481Informations de copyright
© 2023. The Author(s) under exclusive licence to Japanese Society of Anesthesiologists.
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