Use of Ethanol Lock Therapy to Reduce the Incidence of Catheter‐Related Bloodstream Infections in Home Parenteral Nutrition Patients

Abstract

ELT shows promise in reducing the incidence of CRBSI in the frequently infected HPN population. Further studies are warranted.

Use of Ethanol Lock Therapy for Children with Intestinal Failure on Long-Term Parenteral Nutrition

“…In a small series, adults on home PN were treated with 70 % ethanol for 2-4 h anywhere from 2 to 7 days per week. This treatment resulted in a significant decrease in CRBSI from 8.3 to 2.7 per 1,000 catheter days (Opilla et al 2007). Similarly, a randomized trial in adult oncology patients found that 70 % ethanol used for 2 h daily decreased the infection rate from 3.1 to 0.6 per 1,000 catheter days.…”

“…Ethanol lock therapy (ELT) is currently used in certain patient populations for both the prevention and treatment of CRBSI (Broom et al 2008;Dannenberg et al 2003;Metcalf et al 2004;Mouw et al 2008;O'Grady et al 2002;Onland et al 2006;Opilla et al 2007). Similar to other lock solutions, the technique involves instilling ethanol within the CVC lumen and allowing it to dwell for a period of time while the catheter is not in use.…”

“…If the ethanol is withdrawn from the catheter, there is theoretically an increased potential for catheter thrombosis; however, if the ethanol is flushed into the venous circulation, there is the potential for systemic toxicity (Broom et al 2008). Thus far, reported symptoms after flushing ethanol include nausea, dizziness, or experiencing an odd taste (Broom et al 2008;Opilla et al 2007;Sanders et al 2008;Slobbe et al 2010). However, there have also been studies using ethanol locks where the patients report no associated symptoms (Jones et al 2010;Kayton et al 2010;Mouw et al 2008).…”

Role of Ethanol Locks in Reducing Bloodstream Infections in Adults on Parenteral Nutrition

“…Trials in the adult population have included patients with long-term central venous catheters, such as dialysis, oncology, and PN patients, and have shown variable results. [5][6][7][8] The goal of this study was to further evaluate benefits of adding prophylactic ELT to all patients with silicone-based tunneled catheters in adult patients on home PN for an advanced form of intestinal failure (type 2 or type 3) as defined by the European Society for Clinical Nutrition and Metabolism (ESPEN). 9 The primary outcomes evaluated were the rates of CLABSI and resulting hospitalizations in patients before and after the initiation of the ELT protocol.…”

Management of catheter-related infection

“…Taurolidine (a derivative of aminosulfonamide-taurinamide with antimicrobial activity against a broad range of bacteria and fungi), minocycline-EDTA (EDTA is a potent calcium and iron chelateur and has antistaphylococccal and anticandidal activity), gentamycine-citrate solution, ethanol and hydrochloric acid are currently under evaluation [33]. Among them, ethanol appears promising and a double-blind randomized trial to evaluate the efficacy of a 50% ethanol-lock solution instilled for 1-3 h once daily is ongoing [34,35]. Tetrasodium-EDTA, has been tested in vitro and ex vivo with explanted infected hemodialysis catheters [36].…”