C53-38 Chlorhexidine-Induced Anaphylactic Cardiac Arrest Following PICC Line Insertion: A Rare Peri-Procedural Complication

Abstract Introduction Chlorhexidine is a widely used antiseptic in medical procedures due to its broad antimicrobial properties and favorable safety profile. However, severe hypersensitivity reactions, including anaphylaxis, have been increasingly reported. We present a rare case of chlorhexidine-induced anaphylactic cardiac arrest occurring during peripherally inserted central catheter (PICC) placement. Case Presentation A 75-year-old male with diabetes mellitus, peripheral vascular disease, and chronic left foot osteomyelitis was admitted for worsening lower extremity cellulitis. Following partial first-ray resection and subsequent vascular interventions, a PICC was placed to facilitate prolonged intravenous antibiotics. During the procedure, the patient developed sudden-onset anxiety, nausea, flushing, and agitation, rapidly progressing to unresponsiveness and pulselessness. Cardiopulmonary resuscitation (CPR) was initiated, and return of spontaneous circulation was achieved after seven minutes. Endotracheal intubation revealed marked vocal cord edema consistent with anaphylaxis. The chlorhexidine-coated PICC was removed immediately, and the patient was treated with intravenous steroids and antihistamines. He was successfully extubated after 48 hours with complete neurological recovery and was discharged home on oral antibiotics. No other potential triggers were identified, and the reaction was attributed to the chlorhexidine-impregnated catheter coating, given the clear temporal association and lack of alternative etiologies. Discussion Although chlorhexidine anaphylaxis is rare, it is an increasingly recognized cause of severe intra- or peri-procedural reactions, particularly with chlorhexidine-coated catheters, dressings, and devices. Sensitization may occur with prior hospital exposures; therefore, awareness of this potential complication is crucial, especially in patients with multiple prior interventions. This case highlights the importance of maintaining a high index of suspicion for chlorhexidine in otherwise unexplained intra- or peri-procedural cardiovascular collapse. Prompt recognition, immediate removal of the antigen source, early airway protection, and epinephrine administration followed by adjunctive corticosteroids and antihistamines are critical for favorable outcomes. Systematic documentation of chlorhexidine allergy is essential to mitigate recurrence. This abstract is funded by: None