My 14 year old son recently had surgery. The procedure was a simple septoplasty, done on an outpatient basis. Along with the usual parental worries one experiences when her child needs to have surgery, I had another concern, namely, the unintentional infusion of toxic substances, phthalates, into my son's body.

What's that? Phthalates, you say? (Pronounced Thal-lates.) In the past year, as I have learned more about environmental issues and health, I have come to learn about PVC plastic, polyvinyl chloride. That's the plastic that you find in shower curtains, check book covers, edge molding in homes, inflatable toys, teething rings, and 25% of all health care products, according to the Health Care Industry Manufacturers Association.

While PVC has many seemingly "good" uses, it is responsible for the production of dioxin, both in its manufacture and disposal (if incinerated). Phthalates are one of the substances added to PVC to give it additional flexibility and enhance its properties. Phthalates have been demonstrated to leach from the bags, into the solution, and be infused via IV tubing into people's bodies. In California, many of the major health care companies are being sued under Prop. 65, a right to know law which makes it illegal not to tell people before you expose them to a carcinogen or toxic substance. For over a decade the health care industry has known that phthalates leach out of PVC plastic medical devices and into patients, but has continued to maintain that the levels of exposure were "safe." Proposition 65 was passed by California voters because they were concerned that regulatory agencies were not protecting them from exposure to dangerous chemicals. Suits brought under this statute usually result in reformulation of the products causing the exposure, but so far many in the medical device industry would rather fight than switch.

Phthalates (DEHP) are probable carcinogens, and once inside the body, can metabolize to MEHP, a cardiotoxic substance. In any event, it's not a good idea to receive even small doses of this substance intravenously. I conveyed my concern about phthalates and provided literature to the health care team at the hospital including the pharmacist, the chief of anesthesia, the charge nurse of surgical services and my son's surgeon. I am happy to report that everyone I spoke with, appreciated my concern, and agreed to work to ensure that my son was exposed to the least amount of PVC products possible. I began these communications with the health care team through a series of conversations, voice messages, and emails which commenced about six weeks prior to my son's surgery. Just prior to the surgery, I was again in contact with the team. On the day of surgery when we arrived at the hospital's pre-op unit, a box of glass IV bottles and vented IV tubing sets for my son were perched on the counter. Everyone along my son's path at the hospital had seemingly been informed about the glass IV bottle request, and wanted to learn more about the issues with PVC products in health care. As he went into surgery, the box of glass IV bottles went along with him, and when he emerged from surgery in the recovery room, the glass IV bottles followed along. In the Post Anesthesia Care Unit (PACU) as he was waking up from anesthesia, one of the nurses asked about the glass IV bottles. Alex, groggy and emerging from anesthesia, began to give the nurse a slurred speech lecture on phthalates stating that "My mom doesn't want me to get any IV carcinogens today." His comment in that stuporous state sounded funny, resulting in most of us struggling to hold back our laughter and tears.

In this case, we were fortunate, as this was elective surgery, and we had ample time to make the request and have it honored. In cases of urgent surgery or emergency care, non-PVC products are not likely to be available unless and until consumers begin requesting them. If you want to learn more about the concerns around phthalates, visit the Health Care Without Harm website at www.sustain.org/hcwh or contact Charlotte Brody, co-coordinator for the Health Care Without Harm Campaign at 703-237-2249.

Phthalates are actually a large family of chemicals with varying toxicity. Their largest single use is in PVC. DEHP is a carcinogen in animals and probably a carcinogen in humans. Animal tests show that many phthalates are spermatotoxins and that the developing fetus and infant are much more susceptible to spermatotoxicity than adult animals (Foster P. Assessing the effects of chemicals on male reproduction: Lessons learned from di-n-butyl phthalate). Some phthalates are also estrogenic (Harris CA, Henttu P, Parker M et al. The estrogenic activity of phthalate esters in vitro. Environ Health Perspect 105(8):802-811, 1997). There is also concern that phthalates in respiratory tubing, known to be swept into the lungs by the passing air column, may act as respiratory sensitizers contributing to bronchiospasm or even respiratory failure in preterm infants (Roth B, Herkenrath P, Lehman HJ, et al. Di-(2-ethylhexyl)-phthalate as plasticizer in PVC respiratory tubing systems: indications of hazardous effects on pulmonary function in mechanically ventilated, preterm infants. Eur J Pediatr 147:41-46, 1988.)

**Special thanks to Jane Williams, Dr. Ted Schettler MD, MPH and Pat Donehower, RN, MS for their review and input on this article.

Top | Home