Use of ethanol lock therapy to reduce the incidence of catheter-related bloodstream infections in home parenteral nutrition patients.
BACKGROUND
Catheter-related bloodstream infection (CRBSI) is a serious complication for home parenteral nutrition (HPN) patients. To reduce the incidence of infection in frequently infected HPN patients, prophylactic ethanol lock therapy (ELT) was initiated.


METHODS
Nine patients were selected as candidates for ELT because of their history of recurrent CRBSI. Diagnosis of CRBSI was determined by symptoms correlating with positive peripheral and access device blood cultures. Medical-grade ethyl alcohol 25%-70% was instilled into the central venous access device and allowed to dwell for 2-4 hours. The incidence of CRBSI and catheter changes was compared before and after initiation of ELT.


RESULTS
Nine patients experienced 81 CRBSIs (8.3 per 1,000 catheter-days) before starting ELT vs 9 infections (2.7 per 1,000 catheter-days: relative risk [RR], 0.325; confidence interval [CI] 95%, 0.17-0.64) after ELT. Catheter changes were also reduced from 69 (7.0 per 1000 days) before ELT to 1 (0.3 per 1,000 days: RR, 0.043; CI 95%, 0.01-0.25) after ELT. No significant adverse effects were noted, although some patients complained of transient dizziness and nausea.


CONCLUSIONS
ELT shows promise in reducing the incidence of CRBSI in the frequently infected HPN population. Further studies are warranted.
Opilla
Marianne T
MT
Department of Nursing, Nutrishare, Inc., Elk Grove, California, USA. mopilla@nutrishare.com
Kirby
Donald F
DF
Edmond
Michael B
MB
D016470:Bacteremia / Q000453:epidemiology* / Q000517:prevention & control*; D002405:Catheterization, Central Venous / Q000009:adverse effects*; D002408:Catheters, Indwelling / Q000009:adverse effects; D003428:Cross Infection / Q000453:epidemiology / Q000517:prevention & control; D004305:Dose-Response Relationship, Drug; D000431:Ethanol / Q000009:adverse effects / Q000494:pharmacology*; D006801:Humans; D016331:Parenteral Nutrition, Home / Q000009:adverse effects*; D016896:Treatment Outcome
D000431:Ethanol