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Given the growing incidence
of latex allergy, being prepared to care for persons with the sensitivity
in a rapid, comprehensive, and latex-free manner is critical. A utilitarian
approach is to use a rolling piece of equipment similar to "code"
or "crash" cart that can be obtained in the emergency department
and then accompany the patient throughout all areas in the hospital. Resuscitative
items are included in the listing, which covers basic latex-free medical
devices from major American manufacturers. This listing is current as
of December 1997. The list is not inclusive; nor does mention imply endorsement.
Not all models of a
particular product listed are necessarily latex-free, and thus when stocking
a cart it is important to clarify the model number of the product with
the manufacturer to double-check content. It is especially advisable to
do this well before the items are needed, because there is no way to visually
check for latex content. More and more manufacturers are labeling the
exact components of the medical device that contains the latex, and new
Food and Drug Administration regulations mandate that all latex components
be labeled as such in any medical device1 by September 30, 1998. Manufacturers
are becoming very responsive to requests for documentation of latex content
in their products, and these documents can easily be kept on file for
updating.
As products change
and purchasing contracts are revised, the product, identified by model
number; can and should be verified before stocking.
I acknowledge the comprehensive
work on this subject by the Department of Anesthesiology, Rush-Presbyterian-
St. Luke's Medical Center, Chicago, IL., and Latex Allergy Nursing/Health
News, and thank Laura Coopersmith, PharmD, Vail Valley Medical Center,
Vail, CO, for her assistance.
Tables
Latex-free
respiratory equipment
Latex-free
monitoring and patient care equipment
Medications
Pharmaceutical
company access
Manufacturer
access
Table 1: Latex-free
respiratory equipment
Oral airways-polyethylene,
ethylene vinyl acetate, and polypropylene
Hudson Respiratory
Care, Inc. (Temecula, CA)
Vital Signs, Inc. (Totawa, NJ)
Reliacare Express (Landover, MD)
Curity Airways-Ovassapian Airway-Kendall Healthcare Products Co. (Mansfield,
MA)
Guedel Oral Airway-Smiths Industries Medical Systems (SIlMS, Inc.)/Portex
Inc. (Keene, NH)
Laryngeal mask airways-silicone
Gensia, Inc.
(San Diego, CA)
Nasopharyngeal airways-polyvinyl
chloride
S/Portex Inc.
Face masks (may
have latex in elastic strap that should be replaced when stocked)
Rellacare Express
King Systems Corp. (Noblesvtile, IN)
SIMS/Intertech Resources, Inc. (Ft. Myers, FL)
Model 6000 and 6005-Salter Laos (Arvin, CA)
Latex-safe head
straps to retrofit latex elastic fasteners on face masks-silicone
Ohmeda, Inc.
(Madison, WI)
Vital Signs, Inc.
Endobronchial tubes
with continuous positive airway pressure (CPAP) systems-polyvinyl chloride
tube (NOTE: CPAP system breathing bag contains
latex)
Mallinckrodt
Medical, Inc. (Irvine, CA)
Endotracheal tubes-polyvinyl
chloride or silicone tube
Kendall Healthcare
Products Co.
Mallinckrodt Medical
SIMS/Portex
Shiley, Inc. (Division
of Mallinckrodt Group, Inc.)(St. Louis, MO)
Berman Leatherco,
Inc. (Boston, MA)
Stylets-polyvinyl
chloride or aluminum
Marnnckrodt
Medical
Vital Signs, Inc.
SIMS/Portex-blue
line
Manual resuscitator-polyvinyl
chloride, K resin, ethylene vinyl acetate, polyethylene, polypropylene,
and silicone
Infant, pediatric,
and adult-SIMS/Intertech Resources, Inc.
Infant, pediatric,
and adult-Vital Signs, Inc.
PMR 2-Neilcor
Puritan-Bennett (Carlsbad, CA)
SPUR disposable-AMBU,
Inc. (Linthicum, MD)
Laerdal Medical
Corporation (Wappinger Falls, NY)
Armstrong Medical
Industries, Inc. (Lincolnshire, IL)
Bag Easy and Seal
Easy-Respironics Incorporated (Murraysville, PA)
Reliacare Express
Breathing circuits
for anesthesia delivery
Nakomed "Adult
Bellows Subassembly, Polyurethane "-North American Drager (Telford,
PA)
Neoprene Ventilator
Bellows and non-latex "down tube "-Obmeda, Inc. (Madison, WI)
Neoprene Breathing
Bag-Anesthesia Associates, Inc. (San Marcos, CA)
Ventilator breathing
circuits-filters
V ital Signs, Inc.
Pall Biomedical
(Greenvale, NY)
SIMS/Intertech
Resources, Inc.
Volume ventilator
circuits-polyvinyl chloride; k resin; ethylene vinyl acetate; polyethylene;
polypropylene; and silicone
SIMS/Intertech Resources, Inc.
Ventilator
Servo Products
Company (Pasadena, CA)
Table 2: Latex-free
monitoring and patient care equipment
Gloves-sterile, clean,
and surgical-vinyl. neoprene, nitrile, and 5tyrene-butadiene-styrene block
copolymer
Sensicare,
Nitrile, Neolon/Maxxim (Clearwater, FL)
Nitme-Best Manufacturing
Co. (Menlo, GA)
Tactylon-Smart
Practice (Phoenix, AZ)
Dermaprene, Nitrile-Ansell,
Inc. (Eatontown, NJ)
Allergard-Johnson
& Johnson Medical, Inc. (Arlington, TX)
Elastyren-Center
Laboratories/Hermal Dermatology Group (Delmar, NY)
Reichold Protective
Products (Raleigh,NC)
Tillotson Healthcare
Corp. (Bedford, NH)
Electrode pads
Conmed Corp.
(Utica, NY)
Vermont Medical,
Inc. (Bellows Falls, VT)
Valleylab Inc.
(Boulder, CO)
Dantec EMG (Campbell,
CA)
Radial artery catheters
Arrow International, Inc. (Reading, PA) (kits
have syringe with latex plunger - can be replaced with nonlatex syringes)
Central venous catheters
Arrow International,
Inc. (kits have syringes and injection caps with
latex that may be replaced and also contain a Raulerson device, a syringe
for blood flashback that the catheter goes through with a latex seal)
Bard Access Systems,
Inc. (Salt Lake City, UT) (no latex seals)
Medical Parameters,
Inc. (Woburn, MA) (single, double, triple, and oruadruple lumen)
B/Braun (Bethlehem,
PA) (triple lumen catheters)
Catheter introducer
kits
Bard Access
Systems, Inc.
6.5, 6.5, 9 Fr-Medical
Parameters, Inc.
Intravenous catheters
Protectiv
Plus-Johnson & Johnson Medical, Inc. (Arlington, TX)
Insyte-Critikon,
Inc. (Tampa, FL)
Abbocath, Clear-Cath,
and all butterfly needles except 4550, 4721, 4871, and 5827-Abbott (Abbott
Park, IL)
Angiocath-Becton
Dickinson and Company (Franklin Lakes, NJ)
Intravenous tubing-needleless
system without latex ports
Safesite system-B/Braun Medical Products Division
Smartsite-IVAC
Medical Systems (San Diego, CA) (Note: components
from one company's line may not be compatible with others, nor with all
latex free syringe systems)
Walrus latex-free
injection sites, intravenous sets, extension sets, and T-connectors-Medical
Parameters,
Inc. (Woburn, MA)
InterLink systems-Baxter
Healthcare Corp, LV. Systems (Round Lake, IL)
Injection caps-for
replacement of latex caps on multilumen catheters as well as free-standing
heparin locks-male adapter plugs
B/Braun
Abbott
Blood pressure measurement
systems-latex-safe cuff, bladder, tubing and bulb
Technol Orthopaedic Products
(Ft. Worth, TX)
Disposable cuff
- adult/child/neonatal: Datascope Corp. (Paramus, NJ)
Foley Catheters-silicone
(silastic-must be 100% silicone, not just silicone-coated
latex)
Bard USCI
Div. (Billerica, MA)
Kendall Healthcare
Products
Blood transfusion
delivery systems
Y-type HEMA
210 micron filter-Abbott
Bucket-type HEMA
210 micron filter (secondary use only)-Abbott
Blood transfusion
filters
Fenwal-Baxter
Salem sump nasogastric
tube
Argyle-Sherwood Medical
Company (St. Louis, MO)
Syringes-all sizes
(plunger and banel components)
Terumo Medical
Corp. (Somerset, NJ)
Norm-Ject (Air-tite)
(Virginia Beach, VA)
Becton Dickinson
and Company (currently in production)
OR Procedure packs-specialty
products-C-section, Orthopedic, General Surgery, and Laparoscopic Carts-Deroyal
(Powell, TN)
Table 3: Medications
Prefilled syringes
- non-latex plungers
Abboject syringes
(Abbott)
Amidate (Etomidate 2mg/ml)
Aminophylline (25 mg/mi)
Atropine sulfate (0.05 mg/mi and 0.1 mg/mi)
Bretylium tosylate (50 mg/mi)
Bupivicaine hydrochloride (0.25% and 0.5%)
Calcium chloride injection (10% 1.4 mEg/mi)
Dextrose injection (25% and 50%)
Dopamine hydrochloride (40 mg/mi and 80 mg/mi)
Epinephrine (1:10,000 0.1 mg/mi)
Furosemide (10 mg/mi)
Isoproterenol HCl (1:50,000 0.02 mg/mi and 1:5000 0.2 mg/mi)
L-cysteine (Cysteine
HCl injection) (500 mg/jO ml 2.85 mMol/10 ml)
Lidocaine HOl (1% and 2%)
Magnesium sulfate injection (50% 4mEq/mi)
Potassium chloride injection (1.5 mEg/mi and 2 mEg/mi)
Quelicin (Succinyicholine chloride injection) (20 mEg/mi)
Sodium bicarbonate (4.2%-s mEq, 7.5%A4.6 mEq, and 8.4%-b mEg)
TPN electrolytes (multiple electrolyte additive)
Trace elements (4) injection
Thbocurarine chloride (3 mg/mi)
Verapamil hydrochloride (2.5 mg/mi)
Medications in latex-free
vials, tubexes, syringes, and cartridges
Aminocaproic acid injection-vial
Aminophyiline injection-vial
Bicillin C-fl injection-tubex
Bicillin L-A injection-tubex
Bretylium tosylate injection-vial
Clindamycin phosphate-vial
Cyanocobalamin injection-tubex
Daigan injection-vial and tubex
Dextrose-syringe and cartridge
Diazepam-vial, syringe, and cartridge
Digoxin-tubex
Dimenhydrinate injection-tubex
Diphenhydramine HCi injection-tubex
Dorycycline hyclate injection-vial
Epinephrine-tubex
Erythromycin lactobionate-vial
Gentamicin sulfate injection-vial and cartridge
Halothane-bottle
Heparin sodium-cartridge
Hydromorphone HCi injection-vial and tubex
Hydroryzine HCl injection-vial
Influenza virus vaccine-vial and tubex
Leucovorin calcium-vial
Lidocaine HCl with epinephrine injection-vial
Mepergan injection-tubex
Meperidine HCi-tubex and blunt point
Methyldopate HCl injection-vial
Morphine PCA-vial
Morphine sulfate-tubex and bluntpoint
Orytocin injection-vial
Pancuronium bromide-vial
Pentobarbital sodium injection-tubex and blunt point
Phenergan injection-tubex and blunt point
Phenobarbital sodium injection-vial, tubex, and blunt point
Phenylephrine HCL-vial
Phenytoin sodium injection-vial
Phospholine iodide-vial
Premarin-vial
Procainamide HCl injection-vial
Prochiorperazine edisylate injection-vial and tubex
Protopam chloride injection-vial
Secobarbital sodium injection-tubex
Sodium chloride injection-vial
Sodium chloride injection-bacteriostatic cartridge and bluntpoint
Sodium nitroprusside-vial
Sparine injection-vial
SMX/TMP concentrate injection-vial
Thiamine HCI-tubex
Vancomycin HCl-vial
Water for injection-bacteriostatic-tubex
Wycillin injection-tubex
Emergency medications
manufactured in vials with latex stoppers
(Remove metal sheathing encasing the stopper and
the stopper itself with a hemostat, then draw up with a needle-topped
latex-free syringe)
Adenosine-Fujisawa SmithUCline
Corp. (Deerfield, IL)
Antivenin-Trivaient-aU
three vials contain later horse serum control, bacteriostatic water, and
lyophilized antivenin-Wyeth-Ayerst Laboratories, Inc. (Radnor, PA); Coral
snake-Wyeth-Ayerst Laboratories, Inc.
Atropine-Eikins-Sinn,
Inc. (Cherry Hill, NJ)
Calcium gluconate-American
Regent, Astra Pharmaceutical Products (Weetborough, MA), Fujisawa, Eikins-Sinn,
Inc., IDE (Melville, NY), McGuff Company, Inc. (Santa Ana, CA), Rugby
Labs, Inc. (West Hempstead, NY) (Glass amps available from Abbott)
Decadron-American Regent,
Merck & Co. (West Point, PA), Bioline (Ft. Lauderdale, FL), Dixon
Shane Inc. (Philadelphia, PA), Elkins-Sinn, Inc., Geneva Pharmaceuticals
(Broomfield, CO), Kendall McGaw, Major Pharmaceuticals (Auburn Hills,
MI), Rugby, United Research Laboratories (Bensalem, PA)
Dobutamine-Eli Lilly
and Co. (Indianapolis, IN), Abbott, Gensia Labs (San Diego, CA), Schein
Pharmaceutical, Inc. (Brewster, NY), Sanofi Winthrop Pharm. (New York,
NY), ESI Pharma Inc. (Plilladeiphia, PA), Bedford Labs (Bedford, OH),
Astra, Bioline, Diron-Shane, Eikins-Sinn, Geneva, Marsam Pharmaceuticals
Inc. (Cherry Hill, NJ), Kendall McGaw, Major, Rugby United Research Laboratories
Dopamine-Elkins-Sinn
Fentanyl-2 ml, S ml,
and 20 ml all come in glass amps; ESI, Janssen Pharmaceutical Inc. (Titusville,
NJ)
Ketamine-Parke-Davis
(Morris Plains, NJ), Sanofi Winthrop, Abbott, Bedford Labs
Mannitol-Fujisawa, Abbott,
American Regent, Astra, Barter
Midazolam-Roche (Nutle~
NJ)
Nalorone HCl injection-Eikins-Sinn
Neostigmine methylsulfate
injection-Elkins-Sinn
Solu-Medrol-vials are
made without latex in the middle; Upjohn, Abbott, Diron-Shane, Goidline,
Major, Rugby, Schein, United Research Laboratories, Forest Pharmaceutical,
Inc. (Earth City, MO), Hyrex Pharmaceuticals (Memphis, TN), Keene Pharmaceuticals
Inc. (Keene, TX), Pasadena Research Labs (San Clemente, CA), Central Pharmaceuticals,
Inc. (Seymour, IN)
Vecuronium-Marsam, Organon,
Inc. (West Orange, NJ)
(Note: above list includes
products of only three major American pharmaceutical suppliers: Wyeth-Ayerst
Laboratories, ElkinsSinn, Inc., and A. H. Robins Company, Inc.)
Table
4: Pharmaceutical company access
Abbott Laboratories
(780) ABBOTT 3
A. H. Robins Company Inc. (215) 688-4400
American Regent (516) 924-4000
Astra Pharmaceutical Products (780) 236-9933, (508)366-1100
Baxter Hyland (818) 956-3200
Bedford Labs (216) 232-3320
Bioline (Zenith Goidline Pharmaceuticals) (305)491-4002
Central Pharmaceuticals, Inc. (812) 522-3915
Diron-Shane Inc. (780) 202-7770
Elkins-Sinn, Inc. (Wyeth Ayerst) (610) 688-4400
ESI (subsidiary of Wyeth-Ayerst) (610) 688-4400
Forest Pharmaceutical, Inc. (780) 678-1605
Fujisawa SmithKline Corp. (847) 317-0600
Genesia Labs (619) 546-8300
Geneva Pharmaceuticals (780) 525-8747
Goidline Laboratories, Jnc. (305) 491-4002
Hyrer Pharmaceuticals (901) 794-9050
IDE (780) 666-8100
Janssen Pharmaceutical, Inc. (609) 730-2000
Keene Pharmaceuticals Inc. (817) 645-8083
Kendall McGaw (714) 660-2000
Eli Lilly and Co. (317) 276-2000
Major Pharmaceuticals (780) 688-9696
Marsam Pharmaceuticals Inc. (609) 424-5600
McGuff Company, Inc. (780) 854-7220
Merck & Co. (215) 652-5000
Organon, Inc. (201) 325-4500
Parke-Davis (780) 223-0432
Pasadena Research Labs (714) 492-4030
Roche Laboratories (780) 526-6367
Rugby Labs, Inc. (516) 536-8565
Sanofi Winthrop Pharmaceuticals (780) 446-6267
Schein Pharmaceutical, Inc. (914) 278-3724
Upjohn (Pharmecia & Upjohn) (614) 764-8100
United Research Laboratories (215) 638-2626
Table 5: Manufacturer
Access
Abbott Laboratories
(780) ABBOTT 3
Arrow International, Inc. (780) 233-3187
Artec, Inc. (780) 727-8321
B/Braun (780) 523-9626
Bard-Cardiopulmonary Division (780) 327-4227
Bard-Access Division (780) 545-0980
Barter Healthcare (780) 933-0303
Becton-Dickinson (780) 817-1702
Best Manufacturing Co. (780) 241-0323
Critikon, Inc. (780) 237-2033
Dentec EMG (780) 835-9873
Datascope-Patient Monitoring Div. (780) 288-212
Deroyal (780) 251-9864
Gensia, Inc. (780) 788-7999
Hermal Pharmaceutical Laboratories, Inc. (780) 35~'
ICU Medical, Inc. (780) 824-7890
WAC Medical Systems (780) 482-WAC
Johnson & Johnson Medical (780) 255-2500
Kendall Heaithcare Products Company (780) 962-'
King Systems Corp. (780) 642-5460
Mallinckrodt (888) 744-1414
Marrim Medical, Inc. (Sensicare and Neolon latex gloves) (780) 727-7340
Medical Parameters, Inc. (617) 933-5558
Norm-Ject (Air-tite) (780) 231-7762
North American Drager (780) 462-7566
Olimeda (780) 345-2700
Pall Biomedical Products (780) 289-7255
Reichoid Protective Products (780) 448-3482
Reliacare Express (780) 556-3210
Salter Labs (780) 235-4203
Servo Products Company (780) 621-2599
Sherwood Medical Company (780) 325-7472
SmartPractice (780) 822-8956
Smiths Industries Medical Systems Porter and
Intertech Divisions (780) 258-5361
Tecnol (780) 832-6651
Terumo Medical Corp. (780) 283-7866
Wyeth-Ayerst Laboratories, Inc. (780) 999-9384
Reference: Federal
Register. Vol. 62, No. 189. Sept. SO, 51021-SC.
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