Ethanol Lock Therapy for the Prevention of Nontunneled Catheter‐Related Bloodstream Infection in Pediatric Patients

Abstract

Background: Ethanol lock therapy (ELT) has been reported as being effective in preventing central line-associated bloodstream infection (CLABSI) in tunneled (or long-term) central venous catheters (CVCs). To the best of our knowledge, no studies have evaluated this therapy in relation to nontunneled (or short-term) CVCs. Objective: To evaluate the effectiveness of ELT in preventing CLABSI in nontunneled CVC in pediatric patients. Methods: This randomized clinical trial was conducted with children aged 0-5 years and >2 kg in weight, in whom a double-lumen polyurethane nontunneled CVC had been inserted. Patients with catheters inserted in an emergency situation, critically ill patients, and/or those with a history of hypersensitivity or allergic reactions to ethanol were excluded from the study. The variables evaluated were CLABSI, etiological agents, adverse events, and the mechanical effects of ethanol on the catheter (breakage and obstruction). Results: The CLABSI rate was lower in the ELT group compared with the control group (P = 0.0177). However, when the occurrence of CLABSI was evaluated per 1000 catheter-days, no significant difference was found between the groups (P = 0.077). The frequency of side effects and catheter breakage was greater in the ELT group (P = 0.0001 and P = 0.0005, respectively). Conclusions: The CLABSI rate was statistically significantly reduced in the ELT group compared with the controls, but the analysis of frequency per catheter-day showed no significant difference between the groups. Thus, we should not recommend ELT for CLABSI prophylaxis in nontunneled polyurethane CVC, which requires further clinical trials. (JPEN J Parenter Enteral Nutr. 2019;43:1044-1052

Prolonged Use of Ethanol Lock Prophylaxis With Polyurethane Catheters in Children With Intestinal Failure: A Single‐Center Experience

“…ELP was administered daily in both lumens in children <5 years of age and >2 kg. 16 In contrast to our study, a higher frequency of catheter breakage was detected in the ethanol group. Catheter sizes were not reported, but because only double-lumen catheters were used, it is likely that smalllumen catheters were used.…”

“…Only 1 randomized control trial has clinically evaluated the use of ELP in double‐lumen polyurethane catheters during a short‐term period. ELP was administered daily in both lumens in children <5 years of age and >2 kg 16 . In contrast to our study, a higher frequency of catheter breakage was detected in the ethanol group.…”

“…15 Also, a recent randomized controlled trial found an increase in catheter breakages with the short-term use of ELP in polyurethane CVCs. 16 Therefore, although ELP has been recommended in polyurethane CVCs, these concerns have limited its adoption in clinical practice.…”

“…However, there has been general concern to use ELP in polyurethane catheters because it may cause greater integrity changes 14 despite in vitro evidence, which has shown only negligible alterations in both types of catheters 15 . Also, a recent randomized controlled trial found an increase in catheter breakages with the short‐term use of ELP in polyurethane CVCs 16 . Therefore, although ELP has been recommended in polyurethane CVCs, these concerns have limited its adoption in clinical practice.…”

Ethanol Lock Therapy Markedly Reduces Catheter‐Related Blood Stream Infections in Adults Requiring Home Parenteral Nutrition: A Retrospective Study From a Tertiary Medical Center

“…Lopes et al performed a randomized clinical study to evaluate ELT therapy for the prevention of nontunneled CRBSI in pediatric patients up to 5 years of age . They found the CRBSI rate was significantly lower in the ELT group compared with the control group, but when the occurrence of CRBSI was evaluated per 1000 catheter days, no significant difference was found between groups.…”