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By: , Jean Hill, Lisa (Mary) Hill
Published: 10/10/2007
When it comes to prepping for eye surgery, povidone-iodine 5% is the solution of choice.[1, 2] But what if a patient presents with a known iodine allergy or has a reaction to the PVP? It's a tough call, as many of the alternatives either aren't as effective as PVP or are toxic to the cornea.
Is the patient really allergic?
Whether it's the surgeon, OR nurse or tech who performs the scrub, we rarely have the time for skin-testing or in-depth investigation. Further, patients - and often healthcare workers - use the term "allergy" for any type of adverse reaction, from skin rash to nausea and vomiting to anaphylaxis. When you also consider that manufacturers of povidone-iodine preparations list known sensitivity to iodine or its other components as a contraindication, it becomes all the more important that you understand allergy and sensitivity and ask the right follow-up questions when a patient reports an "allergy" to iodine, seafood or a skin cleanser.[3]
The American Academy of Allergy, Asthma and Immunology says that "contact dermatitis caused by topically applied iodine-containing antibacterials does not indicate an allergy to iodine. Anaphylaxis to these preparations is exceedingly rare and not proven to be due to iodine."[4] But does an allergy or hypersensitivity to iodine indicate sensitivity to PVP?
Often, "iodine allergy" is a reaction to radiocontrast media (RCM for short) or to seafood. If you can determine that a patient's stated allergy to iodine was to RCM or shellfish, it's unlikely he'd have a skin reaction to PVP. If in doubt, report to the physician as many details as possible and follow his orders or your facility's policy. If you've determined that the "allergy" was to PVP, ask about the specific reactive symptoms. Povidone-iodine combined with a detergent can cause corneal damage and should never be used.[5] Itching, burning, and chemosis may result from using a 10% solution rather than the diluted 5% PVP.[6] Conveniently available in the form of applicators, 10% PVP is reportedly used on lids and lashes. On the conjunctiva, 10% PVP may cause irritation - the 5% formula is much better tolerated and is recommended for use directly on the conjunctiva.[6,7]
A patient may report an "allergy" to a previous topical application of povidone-iodine without knowing sufficient details about the strength or if the detergent form of PVP had been used. If this is the case, you may want to conduct a patch test or a trial with a 5% PVP solution. But this isn't always practical or reasonable, so you need an alternate to 5% PVP to prepare the eye for surgery.
Peer practice
The American Society of Ophthalmic Registered Nurses asked its members (n=177) in January 2004 what they used in practice as an alternative to PVP. Here's a rundown of those products:
Put it to use
Povodine iodine 5% remains the pre-op periocular disinfectant of choice because of studies demonstrating superior antiseptic qualities and safe use in the eye.[1,2,5,6,7] Based on the survey results, it's obvious many products - not all of them good choices - are used as alternatives when patients have stated iodine allergies. Fortunately, the incidence of PVP sensitivity is infrequent. However, if you don't have enough information or time to validate PVP sensitivity, you must find a substitute. Based on our literature review, chloroxylenol 3% holds the most promise as a pre-op lid and lash cleanser. Unlike alcohol-based products, CHG or hexachlorophene, it's safe for use around the eye; it doesn't require dilution or special storage like benzalkonium chloride; and it's effective against many organisms, including some viruses.
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