What a dilemma! Let me address the easiest part first. IV needles
are still stainless steel. However, the needle does not stay in your
arm ? and has not for at least 25 years. Once the vein is breached,
the needle is pulled out and the plastic/PVC/silicone/etc tubing stays
in place. Having a clot where the IV is inserted is not an unusual
occurrence. Advise your surgeon before surgery that you are prone to
clots at IV sites, and they may give you anticoagulants after surgery
to prevent this.
?Originally, a peripheral IV was simply a needle that was taped in
place and connected to tubing rather than to a syringe. Today,
hospitals use a safer system in which the catheter is a flexible
plastic tube that originally contains a needle to allow it to pierce
the skin; the needle is then removed and discarded, while the soft
catheter stays in the vein.
A peripheral IV cannot be left in the vein indefinitely, because of
the risk of insertion-site infection leading to cellulitis and
bacteremia. Hospital policies usually dictate that every peripheral IV
be replaced (at a different location) every three days to avoid this
complication? Some hospitals change the IV tubing every 48 hours.
?Siliconised, beveled, back cut ground stainless steel needle for
smooth & painless vein puncture.
(A) All cannulas are made of virgin PTFE(Poly Tetra Fluoro Ethylene)
double tapered beveled tip siliconised catheter
(B) Thin wall thickness of the catheter allows maximum flow rate for a
special gauge of cannula
(C) Catheter with radio opaque lines are also available
I noticed on this site, that some tubing is manufactured from non
toxic non irritant PVC.
I was unable to find anything about allergies to Tupperware. Is this
a new reaction? Have you always had a reaction to Tupperware?
Tupperware can retain oils and spices? would it be possible for your
skin to have come in contact with some residual irritant, such as
Di(2-ethylhexyl)phthalate , also known as DEHP, is a plastic softener.
?DEHP is a chemical compound added to polyvinyl chloride (PVC) plastic
during the manufacturing process to make the final product flexible,
strong, and moldable into various shapes and designs. By weight, DEHP
makes up 20% to 40% of PVC products on average.?
?As frontline care providers, nurses should take the following steps
to learn more about the risks of DEHP and to protect their patients:
? Substitute non-DEHP and non-PVC products when caring for vulnerable
populations. (Go to www.sustainablehospitals.org and
? Read package inserts?if the product calls for non-DEHP tubing or is
lipophilic, which increases its leaching potential, use administration
sets made from alternative materials such as polypropylene.
? Urge the FDA to require labeling of products that contain DEHP.
? Work with your institution?s purchasing department to obtain samples
of alternative products and get involved in training colleagues when a
new product is implemented.
? Volunteer to work in your unit on clinical trials of alternatives to
? Report adverse reactions to DEHP to the FDA MedWatch program (go to
?When DEHP enters the human body, the compound is metabolized into
various substances that are more readily excreted. Unfortunately, the
most important of these metabolites, mono-ethylhexyl phthalate (MEHP)
is thought to be responsible for much of DEHP?s toxicity. The enzymes
that break down DEHP into MEHP are found mainly in the intestines but
also occur in the liver, kidney, lungs, pancreas, and plasma. Because
conversion of DEHP to MEHP occurs primarily in the intestinal tract,
exposures to DEHP by ingestion may be more hazardous than by
intravenous exposure, which largely bypasses the intestinal tract.?
? DEHP does not appear to be readily absorbed through the human skin.
Wester et al. (1998) estimated that dermal absorption amounts to
approximately 1.8% of a 24-hour applied dose of DEHP solubilized in
? No other reports were located regarding dermal absorption of DEHP in humans.
? DEHP has been shown to be poorly absorbed through the skin of
laboratory animals. Dermal absorption was reported to be approximately
5% in rats exposed for 7 days to an initial dose of 30 mg DEHP/kg
(dissolved in ethanol). XLII
? The mean calculated dermal absorption rate was 0.242 micrograms/cm^2/hour
? In-vitro studies of DEHP absorption through human, rat and porcine
epidermal segments confirm the poor dermal absorption of DEHP. XLI?
It seems that PVC tubing is preferred because if its superior
qualities: resistance to kinking, strength, clarity, and being able to
withstand sterilization by radiation. Acording to the link below,
there is no other material that can match PVC?s qualities.
?Nevertheless, there are several commercial offerings of non-PVC
medical tubing available on the market. Tubing made by one device
company, for instance, employs a polybutadiene-based material that is
translucent and kinks easily. Another tubing made by a different
company features a three-layer construction, with the outer layer
consisting of plasticized PVC and the inner layer of a polyolefin
material. As yet, however, no substitute has been widely accepted as a
chlorine-free replacement for PVC-based materials.?
?In the United States, one fourth of all plastic medical products are
made of polyvinyl chloride, including most IV bags and tubing . A
chemical added to polyvinyl chloride plastic (PVC) to make it soft and
pliable can leach from IV bags  and tubing [3A-B] into blood [4A-B]
or medications [5A-C] being administered into a patient's veins. Like
PVC children's toys, vinyl IV bags and tubing need chemical additives
called phthalates to make the stiff plastic more flexible. Phthalates
are not bound to the PVC molecules in the plastic, making it easy for
these chemicals to migrate out of the PVC IV bag or tubing and into
the solution they contain .
The chemical added to PVC, di-2-ethylhexyl-phthalate (DEHP), has been
identified by the United States Environmental Protection Agency as a
probable human carcinogen . Scientific studies have shown that DEHP
may also damage the heart , liver [9A-E], testes[10A-D], and
kidneys  and interfere with sperm production?
Certain IV drugs can cause leaching of DEHP into the solution:
?According to the Handbook on Injectable Drugs, the following drugs,
like Taxol and Taxotere, have been shown to increase the leaching of
DEHP from PVC plastic into the solution [5A]
Chemotherapeutic: Etoposide (VePesid) and Teniposide (Vumon)
Antianxiety: Chlordiazepoxide HCL (Librium)
Antifungal: Miconazole (Monistat IV)
Immunosuppressive: Cyclosporine (Sandimmune) and Tacrolimus (Prograf)
Nutritional: Fat Emulsions and Vitamin A.?
?IV containers made of glass or polypropylene and other polyolefins
are available for purchase by health care institutions [14, 15, 18].
But for the most part, the IV bags and tubing market is dominated by
the two leadine manufacturers of PVC intravenous equipment, Baxter
Healthcare Corporation and Abbott Laboratories. While Baxter offers
non-PVC containers for blood component storage, bone marrow banking
and nutritional products  and distributes non-PVC IV bags and
tubing in Europe  the company has not made PVC-free and DEHP-free
alternative IV bags available for purchase in the United States.
PVC-free IV tubing is available in Europe but not in the United
States. At the present time, PVC tubing made without DEHP or lined
with polyethylene are the only available U.S. alternatives. PVC-free
and DEHP-free materials will only become widely available in the
United States if health care professionals, health care institutions
and consumers demand them.?
?Talk with your health care provider about establishing a preference
for PVC-free and DEHP-free IV bags and other medical equipment. Your
physician or nurse may not know about DEHP and PVC. Ask her or him to
read this alert and the noted reference materials.?
?? Bring copies of this alert to your local hospital's pharmacy and
purchasing departments. Ask for their policies on purchasing and use
of PVC IV bags and tubing. Ask them to consider adopting a purchasing
preference for PVC- free products. More information about PVC-free and
DEHP-free alternative products is available at the University of
Massachusetts at Lowell's sustainable hospitals project website:
www.uml.edu/centers/LCSP/ or from the HCWH website: www.noharm.org.
?PVC, a plastic found in 25% of all hospital products has been
associated with the formation of dioxin
compounds during both its? manufacture and disposal (if incinerated).
Dioxin is a proven human carcinogen according to the World Health
Organization?s International Agency for Research in Cancer (IARC)
?DEHP (di-ethylhexyl phthalate) is an additive used to make PVC more
flexible, yet it does not actually bond with the PVC. It can leach
into the surrounding environment. Scientific studies have shown that
DEHP is a
reproductive, cardiac and hepatic toxin in animals. An expert panel of
the National Toxicology Program concluded that DEHP is a reproductive
and developmental toxin and that some infants and adults may be at
risk from excessive exposures during medical care. These conclusions
were recently affirmed by the FDA.
Government findings for safe intravenous exposure levels do not exist.
Safe effective PVC-free alternatives exist.?
?In the event you cannot get PVC-free IV products, insist that staff
read and follow recommendations found on the package inserts for
product storage. PVC IV bags should not be stored in blanket warmers
can accelerate the rate of leaching of DEHP). Use digital thermometers.
Notify your physician, anesthesiologist and hospital pharmicist well
in advance and verify your request in advance of your procedure.
Notify your physician of your preferences.?
?Device makers traditionally have had simple demands of the medical
plastics they use. While clarity is foremost, durability and
resistance to sterilization also remain key considerations. In
addition to providing exceptional material properties, the current
generation of advanced plastics and elastomers offers other benefits
for medical manufacturers. Among these are improved hemocompatibility,
enhanced radiation sterilization stability, and reduced allergy
?Blood?s tendency to coagulate upon contact with foreign objects
creates a special challenge for manufacturers of devices used in such
procedures as open-heart surgery, dialysis, and catheter insertion. As
a result, tubing, catheters, and similar devices have traditionally
been treated with anticlotting coatings. Research and development at
Vestolit GmbH & Co. KG (Marl, Germany) and Teknor Apex (Pawtucket,
RI), however, is proving that new vinyl compounds made from special
copolymers may exhibit antithrombogenic properties equal to or greater
than those of coated materials.
The science involves incorporating functional copolymer groups
directly and permanently into PVC?s ?backbone,? according to Teknor
Apex, which has purchased exclusive, worldwide rights to the novel
material developed by Vestolit. Unlike standard antithrombogenic
coatings, Vestolit resins are nonextractable. The bioactive components
of the copolymers simulate the antithrombogenic ?messages? generated
in the lining of blood vessels by heparin, a naturally occurring
?Curing Process for Synthetic Polyisoprene Latex
Dip Molding Process Reduces Latex Allergy Risks
Apex Medical Technologies Inc. (San Diego), which specializes in
nonlatex elastomeric thin film dip molding, has developed a curing
process for synthetic polyisoprene latex that provides several notable
benefits to medical device makers. According to Mark McGlothlin,
company president, ?Conventional methods use accelerators, rubber
accelerators.? He says the new process substitutes organic peroxides
that don?t rely on any accelerators and thus avoid the allergies
usually associated with the accelerators. ?Ours differs in that we
really can?t form nitrosamine if we don?t have anything there to turn
into a nitrosamine,? says McGlothlin.
?The second thing is that we don?t have accelerators so we don?t get
into the type-IV allergens at all. And we have rather clean breakdown
products from the curing system. That?s the main difference. We have a
cleaner system. Our cytotoxicity results are much better; we always
score what is called zero zone of life, which is a very hard thing to
do in rubber articles.?
He believes there are advantages for both manufacturers and end-users.
?For the end-user it?s more of a safety or toxicity issue. There are
so many of these allergy issues around, so the end-user should benefit
from it. From the manufacturer?s perspective, it should lower, in my
opinion, the amount of liability that the manufacturer takes on. They
would be providing the state-of-the-art, best-known technology to
reduce the risk of latex allergy. So they?re doing all in their power
to reduce or eliminate it. In times past, this option was not
available, and now it is.?
Here is a website that lists suppliers of non-PVC IV tubing and
products. Your surgeon could order supplies for your surgery, with
these sites, through the hospital?s purchasing department, but they
will need plenty of advance notice.
This is an interesting topic, except you seem to be allergic to polyurethane:
?Thermoplastic polyurethanes (TPUs) combine patient comfort with ease
of use, design flexibility, and excellent processability, and
currently are used to create oxygen masks, medical tubing, catheters,
soft and pliable post-surgical appliances, and other medical parts.
Although they are a small slice of the overall thermoplastic
polyurethane market, medical TPUs are gaining a reputation similar to
the one held by their non-medical siblings. They are flexible, tough,
and rugged materials withstanding abuse without breaking, and
enhancing the performance of many applications.
TPUs provide significant patient benefits. Medical TPUs are free of
plasticizers and cause a low incidence of allergic reactions. And when
compared with other plastic and elastomer materials, TPUs have
excellent nonthrombogenic behavior, meaning blood tends not to clot as
much when it comes into contact with the material. The materials also
soften slightly at body temperature, allowing products such as
catheters to be strong enough for insertion but subsequently soft
enough to lend patient comfort.?
?Other medical TPU properties include low extractables (chemicals do
not leach out of the material), high tensile and tear strength, as
well as excellent abrasion resistance and chemical resistance. The
materials are available in a wide range of shore hardnesses, and are
sterilized using radiation, ethylene oxide and dry heat. Processed by
most standard methods, TPUs are used in injection molding, extrusion
and blow molding.?
?TygonŽ MPF-500 is a medical grade, clear non-PVC polymer available
directly from Saint-Gobain Performance Plastics. This tubing is
designed to replace PVC in medical devices in which DEHP plasticizers
and leachables are not desired. TygonŽ MPF-500 can operate in
peristaltic pump applications up to 100 hours and is ideally suited
for surgical drain, fluid administration and dialysis applications.?
These companies make silicone or silicone coated IV tubing
This page lists DEHP-free products:
You can make your voice heard on PVC products!
In summary, you may indeed be allergic to phthalates and/or
PVC/resin/formaldehyde or even the presurgical iodine or antibacterial
scrubs used. I certainly agree with you that leached phthalates can?t
be good for humans. It appears though, from researching, that
allergies to phthalates manifest as asthma and respiratory problems.
No skin reactions have been reported however. People may react to
substances in various ways, but the reaction is not always a true
allergy ? there are differences. An allergy would elicit an
immunological response, producing antibodies. You may have been
plagued by irritants in the plastic, but it sounds unlike a true
The red marks on your arm that you describe could well have been a
reaction to the IV solution infiltrating (leaking into the tissues),
phlebitis/clotting factors, infection, or as you suspect, a reaction
to the tubing. I urge you to discuss this with your surgeon, well in
advance of your surgery.
This occurs when the tip of the IV catheter withdraws from the vein or
pokes through the vein into surrounding tissue, or when the vein's
wall becomes permeable and leaks fluid. It occurs frequently with
peripheral IVs, and requires replacement of the IV at a different
location. The symptoms of pain and swelling are temporary and not
dangerous, unless a highly irritating medication was being given.
This occurs when fluids are given at a higher rate or in a larger
volume than the system can absorb or excrete. Possible consequences
include hypertension, heart failure, and pulmonary edema.
Administering a too-dilute or too-concentrated solution can disrupt
the patient's balance of sodium, potassium, and other electrolytes.
Hospital patients usually receive blood tests to monitor these
As far as doctors who will work with you, I recommend you contact some
of the agencies on this site.
GWU has doctors that deal with chemical sensitivities:
2150 Pennsylvania Avenue, NW, Washington, DC 20037
e-mail firstname.lastname@example.org or, use this online form
Tee Guidotti, MD, MPH
Medicine - Occupational Medicine and Toxicology
Spina Bifida Association of America
4590 MacArthur Blvd NW Suite 250
Washington DC 20007-4226
This DC organization may be able to refer you to a specialist in
chemical sensitivities. (Children with Spina Bifida are prone to latex
allergies). Physicians who are knowledgeable about latex allergies
will also be up to speed on plastic sensitivities.
This agency may be able to provide you with some information as well.
National Institute of Allergy and Infectious Diseases (NAID)
Office of Communications
National Institute of Allergy and Infectious Diseases
National Institute of Health
Bethesda, MD 20892
Web site: http://www.niaid.nih.gov/factsheets/Allergy.htm
Environmental Health Center-Dallas
8345 Walnut Hill Lane, Suite 220
Dallas, Texas 75231 USA
Phone: 214.368.4132 ? Fax: 214. 691.8432
Clinic Hrs: M-F 9:00-5:00 ? Sat: 9:00-12:00
? Chemical Injury Information Network
Our Toxic Times
P.O. Box 301
White Sulphur Springs, MT 59645
Visit the site at http://www.ciin.org.
Contact: Cynthia Wilson
? The Chemical Sensitivity Foundation
Visit the site at http://chemicalsensitivityfoundation.org
They have World Trade Center information and registry.
MCS Referral and Resources
508 Westgate Rd
Baltimore, MD 21229
Contact: Albert Donnay
His email is email@example.com
WWW Site is http://www.mcsrr.org.
List of allergists in the DC area:
There are support groups in your area for chemically sensitive people:
Have you considered a resin allergy? Plastics contain resins.
?Epoxy resin is a chemical that is part of an epoxy resin system.
Epoxy resin systems are used widely in industry because of their
strong adhesive properties, chemical resistance and toughness. Common
two-part epoxy resin systems contain epoxy resin, catalysts/curing
agents, and diluents and/or other additives. Any of these chemicals on
their own may cause irritant and/or allergic contact reactions.?
?The clinical picture you describe sounds atypical but conceivable, I
suppose. There are numerous reports of contact skin and/or mucosal
reactions to resins involved in making plastics, particularly
epoxyresins (see enclosed abstract). Methyl methacrylate, a monomer of
acrylic resin, is also a relatively common sensitizer. However, it is
less clear how often true sensitivity develops to finished
(polymerized) plastic materials, if at all.
In any event, systemic manifestations apparently occur rarely, if
ever, in association with such contact reactions.
I would think that a pragmatic approach to this patient's situation is
needed since the likelihood of identifying the offending chemical (and
avoiding it completely) is small. The concern about reactions to
intravenous plastic catheter may be approached by using an infusion
set containing a larger bore metal needle instead of an intravenous
plastic catheter for infusions/keep open the I.V. access, etc. The
plastic "wings" typically present at the base of the needle in such
infusion sets can be kept from contacting the skin by covering such
wings with non-irritating tape. I think it highly unlikely that
plastic connectors in the intravenous tubing would present a problem
Formaldehyde is used often in the making of plastics.
?Formaldehyde is one of the most common contact sensitizers, likely
because it is present in so many used materials. Fortunately, textiles
used in clothing now apparently contain only very little formaldehyde.
Although avoidance of formaldehyde by sensitive people is usually
recommended, this is generally only partially successful. Yet, it may
be helpful (see enclosed abstract). Unfortunately, the use of -barrier
creams+ is generally not very helpful. What may be feasible in your
case is the use of Nitrile gloves, which are generally well tolerated.
However, I would check with a manufacturer of such gloves to determine
whether they contain any formaldehyde (your hospital purchasing
department can likely give the name of a nitrile glove manufacturer).
Since some patients with hand eczema initially have problems from
increased moisture under the glove, you may have to apply the steroid
cream before donning the gloves. You may actually get more benefit
from such cream used in this way.?
PTBP formaldehyde resin? Medical tape? Quaternium-15 is a
Finally, are you SURE you don?t have a latex allergy?
I hope this has helped you out. If anything is unclear, please request
an Answer Clarification. I will be happy to assist you before you
Plastic softening agents
DEHP free IV tubing
IV tubing + chemical composition
Silicone IV tubing