Dual Chlorhexidine Iodine Allergy Antiseptic — FRCA Final MCQ

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HardAnaesthetic Equipment & SafetyDual Chlorhexidine Iodine Allergy AntisepticFRCA Final

A 45-year-old man (ASA II) with known anaphylaxis to chlorhexidine requires central venous catheter insertion. He is also allergic to iodine-based skin preparations. What alternative antiseptic can be used?

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Correct answer: B — No skin preparation is possible – cancel the procedure

For patients with documented allergy to BOTH chlorhexidine and iodine-based preparations (povidone-iodine), alternative antiseptics include: octenidine dihydrochloride (Octenisan/Octenisept), or alcohol alone (70% isopropyl alcohol). Octenidine is a cationic antiseptic with broad-spectrum activity and no cross-reactivity with chlorhexidine or iodine. The CVC should ideally be a chlorhexidine-free line (no chlorhexidine-impregnated dressing or catheter). These rare dual allergies require advance planning, pharmacy liaison for suitable products, and clear documentation/allergy labelling.

Reference: NICE – 2017 – CG139 Healthcare-associated infections; MHRA – 2020 – Chlorhexidine allergy