Right heart catheterization (RHC) using balloon-tip Swan Ganz catheters has a central role in the diagnosis and management of many cardiac conditions such as congestive heart failure, pulmonary hypertension, and valvular heart disease. Since most Swan Ganz catheters are constructed with balloons made from latex, their use in patients with a history of latex allergy poses a conundrum. Available latex-free catheters have several limitations including the requirement for large vascular sheaths, poor torque response, and significant expense (cost > 3-fold greater than standard latex balloon catheters). Accordingly, we undertook a retrospective study to assess the safety of performing RHC with latex-containing catheters in patients with a history of contact allergy to latex.
Electronic medical records identified 87 consecutive patients having RHC who had a history of contact allergy to latex. Procedural outcomes of 61 patients with latex-containing catheters were compared to those of 26 patients with latex-free catheters. The primary outcome was the occurrence of periprocedural hypersensitivity reactions. There were no instances of procedural hypersensitivity reactions in either the latex-containing or latex-free groups.
Venous sheath sizes were significantly smaller in the latex-containing group. This allowed expanded options for vascular access, such as brachial veins which were used exclusively with smaller latex catheters.
It is important to emphasize that our patients had only cutaneous reactions to latex. None of the patients had a history of anaphylaxis to latex as we consider this to be a contraindication to use of latex-containing catheters. Patients in this study typically had in-and-out procedures with the Swan Ganz catheter removed in the cath lab at the end of the procedure; average in-body catheter dwell time was < 10 minutes. Therefore, this study does not address the safety of prolonged indwelling latex catheters as is often used for extended hemodynamic monitoring in ICU settings.
It was concluded that in patients with a history of non-anaphylactoid cutaneous allergy to latex, use of balloon tip right heart catheters containing latex was not associated with any hypersensitivity reactions. Latex catheters allow for use of smaller sized sheaths and a wider variety of options for vascular access. Since latex allergy is relatively common, these findings have potential implications for everyday practice.
Reference DOI: https://doi.org/10.1016/j.jscai.2022.100232
Dr. Savage has no conflicts of interest to report.
Image by Fagreia / Shutterstockx
