Jeffrey et al,

A Letter to the Editor in a Nursing Journal (and I do not disparage nurses; my late first wife and my current wife were both nurses) is hardly "Evidence Based Medicine" or a Cochrane Coalition Review with evidence grading from 1 (systematic reviewes or meta-analyses of triple-blind, controlled clinical trials) to 3 (anecdotal case report,s small uncontrolled case series, consensus documents, "expert" opinion), so most of what we do in medicine is "Experience Based Medicine" and is quite often empirical with a jaudiced eye towards efficacy of diagnostic tests, medications, or other treatments and a very clear eye for patient safety with a healthy dose of medical ethics.

As an alternative to petrolatum jelly (vasoline) what Lincare(R), one of the major providers of home/travel medical oxygen in the US, is a commercial product called Roezit(R) [Disclaimer: I have no commercial or other interest in the product or Lincare(R), and only will mention that it empirically worked well for my late 1st wife during the last 4-5 years of her life on supplemental O2 24/7 for drying of the nasal passages, and there is no good reason why it couldn't be applied to dry, cracking lips in an ICU or other medical environment.) This particular commercial product is a petroleum free skin emollient with Aloe vera, Emu oil, and vitamins A and E. The full list of ingredients are:
- Aloe Barbadensis leaf juice;
- Water;
- Glycerin;
- Emu oil;
- Rice Bran oil;
- Dimethicone;
- DEA oleth-3-phosphate;
- Carbomer;
- Triethanolamine;
- Phenoxyethyl parsaben;
- Undecylenoyl PEG-5 paraben;
- Alantoin sodium;
- Hydroxymethyl glycinate;
- Tocopherol acetate (vitamin E);
- DL panthenol;
- Retinyl palmitate (vitamin A).

NOTE: I do not specifically recommend this or any similar commercial products. I just mention these things as measures for patient comfort that do not involve petrolatum jelly (Vasoline), and free medical advice is worth exactly what you pay for it.

Alan
Alan H. Hall, M.D.
Medical Toxicologist

---

Date: Fri, 19 Oct 2012 16:38:31 -0400
From: jclewin**At_Symbol_Here**MTU.EDU

Subject: Re: [DCHAS-L] Vaseline and oxygen
To: DCHAS-L**At_Symbol_Here**MED.CORNELL.EDU

PubMed hit with this,

There is no abstract because it is a short letter.

Title:Petroleum jelly myth

Author(s):Philip Woodrow

Source:Nursing Older People. 16.6 (Sept. 2004): p41.

Document Type:Brief article, Letter to the editor

Library links:

• HuskyFetch

Full Text:

In the otherwise excellent article, 'Oxygen therapy for older people', in your last issue, the myth of not using petroleum jelly (eg Vaseline) on patients' lips if they are receiving oxygen is perpetuated.

There is very little literature or evidence on this issue, but the one valid piece of nursing evidence I have seen is Winslow EH, Jacobson AF (1998) Dispelling the petroleum jelly myth. American Journal of Nursing. 98, 11, 16.

Some American nurses researched this issue. They tried setting fire to petroleum jelly, and only succeeded in melting it. They traced the myth back to manufacturers of oxygen equipment, who meant grease should not be placed on connections for oxygen piping, but unfortunately were not sufficiently specific in their wording. The above article seems to allude to a similar source.

My colleagues and I who work in intensive care regularly place petroleum jelly on the lips of our patients. We probably use more oxygen per patient than any other clinical area and I have never seen nor heard of any patient in ITU either exploding or (the lesser version of the myth) suffering burns to their lips. I have, however, during the course of my career seen many nil-by-mouth patients who suffered from cracked lips.

Further nursing research on this issue would be very welcome, but in the meantime the evidence from the above American research indicates that it is safe to apply petroleum jelly to the lips of patients, and to fail to do so if the patient is at risk of tissue damage (which patients receiving oxygen are) is potentially negligent.

Philip Woodrow Practice Development Nurse Critical Care

Woodrow, Philip

Source Citation (MLA 7^th Edition)

Woodrow, Philip. "Petroleum jelly myth." Nursing Older People Sept. 2004: 41. Academic OneFile. Web. 19 Oct. 2012.

Document URL
http://go.galegroup.com/ps/i.do?id=GALE%7CA122028193&v=2.1&u=lom_mtu&it=r&p=AONE&sw=w

Gale Document Number: GALE|A122028193

On Fri, Oct 19, 2012 at 1:09 PM, Alan Hall <ahalltoxic**At_Symbol_Here**msn.com> wrote:

Neal,

I stand corrected on the need for an ignition source. Nothing like seeing throat cancer patients in VA hospitals wearing supplemental nasal prong O2 and smoking cigarettes through their tracheostomies as used to occur with some deadful regularity in times past.

I suppose a Pubmed or Toxline search (National Library of Medicine) might turn up any incidents that were published in the peer-reviewed medical/scientific literature.

I can say that involving medical supplemental O2 and vasoline, I've never personally come across a case despite practicing in 5 separate fields of medicine since 1977, but that doesn't mean much.

Alan

---

Date: Fri, 19 Oct 2012 09:09:00 -0700
From: neal**At_Symbol_Here**CHEMICAL-SAFETY.COM

Subject: Re: [DCHAS-L] Vaseline and oxygen

To: DCHAS-L**At_Symbol_Here**MED.CORNELL.EDU

Alan =96 you do not need an ignition source; the heat of oxidation is sufficient
It would be interesting to locate actual PT incidents. Where would they be documented? I no longer have an NFPA membership, so cannot search them.

------------------------------------------------------------------------------------

The information contained in this message is privileged and confidential and protected from disclosure. If the reader of this message is not the intended recipient, or an employee or agent responsible for delivering this message to the intended recipient, you are hereby notified that any dissemination, distribution or copying of this communication is strictly prohibited. If you have received this communication in error, please notify us immediately by replying to the message and deleting it from your computer.

ACSafety has a new address:

NEAL LANGERMAN, Ph.D.
ADVANCED CHEMICAL SAFETY, Inc.
PO Box 152329
SAN DIEGO CA 92195
011(619) 990-4908 (phone, 24/7)
www.chemical-safety.com

We no longer support FAX.

From: DCHAS-L Discussion List [mailto:dchas-l**At_Symbol_Here**MED.CORNELL.EDU] On Behalf Of Alan Hall
Sent: Friday, October 19, 2012 8:41 AM
To: DCHAS-L**At_Symbol_Here**MED.CORNELL.EDU
Subject: Re: [DCHAS-L] Vaseline and oxygen

I think you will find that home medical O2 providers will always caution against using vasoline (petrolatum jelly) on the face and particulalry to lubricate the nasal mucosa which even with moisturization aerosols afflicts those receiving chronic medical O2. What they generally recommend is a lubricating cream which does not contain volatile hydrocarbons. These are readily available.

Naturally, there would have to be an ignition source before a fire could occur, but why take a chance when safer alternatives are available? Nothing like process product substitution as a good administrative approach to hazard/risk reduction.

My late first wife was on supplemental medical O2 for the last 5 years of her life, so I did become quite familiar with this issue. Whethere there's any real science behind it or whether it is an "urban myth", I can't say as of today. But the old saw about "better safe than sorry" does come to mind.

Maybe someone wants to do a little bench research in a proper facility and tell us the results?

Alan
Alan H. Hall, M.D.
Medical Toxicologist

---

Date: Fri, 19 Oct 2012 08:31:37 -0600
From: mulcahy.marybeth**At_Symbol_Here**GMAIL.COM
Subject: [DCHAS-L] Vaseline and oxygen
To: DCHAS-L**At_Symbol_Here**MED.CORNELL.EDU

Just curious about this and thought some people on this list-serve might have some insightful thought on a topic I stumbled upon (and if I were still a teacher would be a fun test questions to throw at students just to get them thinking).

I had a newborn nephew who was recently on portable oxygen. At some point my sister-in-law said you aren't allowed to have perfume or Vaseline near the oxygen because it can catch on fire. This struck me as odd that she would be cautioned this way since she was using some type of solvent soaked pad to clean the spot where she was going to be putting an adhesive for the oxygen tube to be put on my nephew's face.

I have never thought of Vaseline being particularly hazardous, so of course I immediate began to consult with Dr. Google. One of the warnings I found online was:

"Never use oil-based face or hair creams, a hair dryer or an
electric razor. It is possible in certain conditions that the combination
of oxygen, oil-based toiletries and a spark from an electrical
appliance, such as an electric blanket, hair dryer, electric razor or
heating pad, could ignite and cause burns. Never use oil based hair
lubricants, face and hand lotions, petroleum jelly products, or
aerosol sprays. Always use water-based cosmetics or creams." (http://www..firsttoserve.com/files/cylinder_oxy.pdf)

I also thought found the article titled "Dispelling the Petroleum Jelly Myth" (someone posted the article in a forum found here http://respiratorytherapydriven.blogspot..com/2007/11/vaseline-and-oxygen-flame-on.html).

Then I decided to call a real medical doctor (my sister) to ask about it. She said that she doubted there was any hard evidence out there that this is a hazard, but that somewhere, someone had an accident, hospital got sued, and now it is a "risk" that is being mitigated in hospitals (including hers).

Anyone out there done experiments to try and catch Vaseline on fire? Anyone know the case where Vaseline was identified as a root cause in an accident involving a patient being burned?

Beyond a intellectual curiosity on the topic, it makes me wonder how we promote safety and what we ask people to focus on. Is is scientifically based (does it need to be)? Is it a knee jerk reaction? Is it a systematic approach? The cartoon below portrays how some people I have spoken to look at OSHA regulations. The problem is that if this is the view a person has of safety regulations/standards, I believe he or she will lose faith in the regulations, potentially not following them and thus losing the benefit they can provide. (Disclaimer: I put this cartoon here not because it is how I view OSHA regulations, but because i think it can help spur conversation.)


Mary Beth