Chlorhexidine is used as an anti-infective coating on many Medical Devices, e.g. Central Venous Cannulae and Urinary Catheters. Chlorhexidine is a significant cause of life-threatening allergic reactions*.
There have been 6 confirmed cases of perioperative anaphylaxis to chlorhexidine in NHS Lothian since 2014, most of these cases involved coated devices and multiple exposures even after anaphylaxis had been diagnosed. Device labelling may not always make the presence of Chlorhexidine obvious. Users should check devices in their area for Chlorhexidine, be aware of and stock alternatives and ensure that they can manage anaphylaxis.
Alternatives to coated devices should be used in patients with known history of chlorhexidine allergy. Potential Chlorhexidine allergy should be considered in patients with a history of allergy/skin sensitivity following previous medical or dental procedures (inc peripheral cannulation or venesection) or to antiseptic creams, body washes or mouth washes. In the event of an acute anaphylactic reaction occurring within 1 hour of insertion of a coated invasive device, this device should be removed as soon as possible and replaced with a suitable alternative.
* Chlorhexidine caused 9% of Life-Threatening Allergic Reactions in the 6th National Audit Project of the Royal College of Anaesthetists (www.nationalauditprojects.org.uk/NAP6Home).