1. Woo, Eileen RN, BS

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A PATIENT WITH A HISTORY of an allergic reaction to synthetic absorbable sterile surgical suture (Vicryl) went to surgery wearing an allergy wristband that said, "Allergy to Vicryl suture material." Despite the warning, the surgeon decided to use Vicryl sutures. Several weeks after the surgery, the patient developed severe pain, swelling, and redness at the surgical site. These signs and symptoms were consistent with those she'd previously experienced when she was diagnosed as having an allergic reaction to Vicryl sutures.


What went wrong?

The FDA has received several reports of allergic reactions associated with suture use. In some of these cases, it isn't clear whether the patient's allergy to the sutures was known before they were used.


In the case described here, the surgeon ignored the patient's allergy wristband, which clearly stated her allergy to Vicryl sutures. Subsequently, the patient had an allergic reaction and required a second surgery to remove the sutures. The second surgery could have been avoided if OR staff had not only acknowledged the patient's allergy but also spoken up on her behalf.

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What precautions can you take?

Health care providers must follow their facility's policy for managing allergy information reported by a patient and take the following precautions:


* Pay special attention to the patient's history of allergies, including allergies to devices or device materials.


* Before surgery, document and flag all allergy information in the patient's medical record.


* If your patient has a known allergy to devices or device materials, place a wristband identifying the allergy on her as soon as possible.


* Make sure the surgeon and the OR staff know about the patient's history of allergies.


* When your patient has a documented allergy to a device or device material, be vigilant and advocate for her to avoid exposure to the allergen.


* Teach your patient to inform all health care personnel (including dentists) about the allergy in the future.


* Advise your patient to always wear medical-alert identification with her allergy information.