Use of an ethanol lock to prevent catheter-related infections in children with short bowel syndrome.
BACKGROUND
Children with short bowel syndrome (SBS) requiring central venous catheters (CVCs) may experience frequent catheter-related infections (CRIs). Treatment strategies include antibiotic- and ethanol-containing locks, with CVC removal if the CRI cannot be cleared. Ethanol lock therapy has been reported for CRI treatment in children but not for CRI prevention.


METHODS
Medical records of children with SBS receiving cycled home parenteral nutrition via a silicone CVC and who received a daily 70% ethanol lock at some time during their therapy were reviewed retrospectively.


RESULTS
Ten patients had 26 CVCs for a total of 3556 catheter-days and received a daily ethanol lock for 4 to 14 hours during a total of 3018 catheter-days. Before ethanol lock therapy (n = 5), there were 6 CRIs in 538 catheter-days (rate, 11.15 per 1000 catheter-days). During ethanol lock therapy in the same 5 patients, the CRI rate decreased to 2.06 per 1000 catheter-days (4 CRIs in 1936 catheter-days). In the 5 patients with no ethanol lock-free period, the CRI rate was 1.85 per 1000 catheter-days. Overall, CRI rate with ethanol lock therapy was 1.99 per 1000 catheter-days (2 CRIs in 1081 catheter-days). Four patients developed 6 CRIs during ethanol lock therapy. Four of these CRIs were cleared with systemic anti-infective and ethanol lock therapy; 2 CVCs were removed owing to infection. No adverse reactions were reported during ethanol instillation.


CONCLUSIONS
A daily 70% ethanol lock for CRI prevention was safe and effective in a series of 10 patients with SBS.
Department of Clinical Pharmacy and Outcome Sciences, Medical University of South Carolina, Charleston, SC 29425, USA.
Elisabeth
E
Mouw
Katherine
K
Chessman
Aaron
A
Lesher
Edward
E
Tagge
D001424:Bacterial Infections / Q000188:drug therapy* / Q000209:etiology; D002405:Catheterization, Central Venous / Q000009:adverse effects* / Q000379:methods; D002408:Catheters, Indwelling / Q000382:microbiology*; D002675:Child, Preschool; D015331:Cohort Studies; D004866:Equipment Contamination; D000431:Ethanol / Q000627:therapeutic use*; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D007223:Infant; D008297:Male; D010288:Parenteral Nutrition / Q000009:adverse effects* / Q000379:methods; D016331:Parenteral Nutrition, Home / Q000009:adverse effects / Q000379:methods; D012189:Retrospective Studies; D018570:Risk Assessment; D012778:Short Bowel Syndrome / Q000175:diagnosis / Q000628:therapy*; D016896:Treatment Outcome
D000431:Ethanol