title: Evaluation of ethanol lock therapy in pediatric patients on long-term parenteral nutrition.
abstract: BACKGROUND
  Pediatric home parenteral nutrition (PN) patients present a unique challenge with risks of catheter-associated bloodstream infections (CABSIs), sometimes requiring subsequent catheter removal. Recurrent infections can lead to line removal and potential loss of venous access in the future.
  
  
  OBJECTIVE
  Demonstrate that weekly ethanol lock therapy decreases CABSIs in long-term home PN patients and decreases line removals due to infections.
  
  
  METHODS
  Beginning August 2007, patients receiving PN with a history of multiple previous CABSIs were started on ethanol lock therapy. Seventy percent ethanol solution was instilled into the central venous catheter (CVC) for 2 hours weekly. Episodes of CABSIs and catheter removal due to infection were documented in patients prior to and after ethanol lock therapy.
  
  
  RESULTS
  Fourteen patients were followed for an average of 690 days after ethanol lock therapy was initiated. These patients were found to average 9.8 CABSIs per 1000 catheter days prior to starting ethanol lock therapy and only 2.7 CABSIs per 1000 catheter days after ethanol lock therapy (P < .001). Prior to ethanol lock therapy, the group averaged 4.3 catheter removals per 1000 catheter days but only 1.0 catheter removal per 1000 catheter days after ethanol lock therapy.
  
  
  CONCLUSIONS
  Our group of patients showed a 73% reduction in CABSIs and a 77% reduction in catheter removal due to infection after ethanol lock therapy. In our patient population, weekly ethanol lock therapy for 2 hours is an effective technique to reduce CABSIs and catheter removal in long-term home PN patients.
authors.affiliation: Department of Pediatrics, Division of Gastroenterology, Hepatology, and Nutrition, Stanford University School of Medicine, Stanford, California, USA.
authors.forename: Kevin P
authors.initials: KP
authors.lastname: Pieroni
authors.forename: Colleen
authors.initials: C
authors.lastname: Nespor
authors.forename: Marisa
authors.initials: M
authors.lastname: Ng
authors.forename: Manuel
authors.initials: M
authors.lastname: Garcia
authors.forename: Melissa
authors.initials: M
authors.lastname: Hurwitz
authors.forename: William E
authors.initials: WE
authors.lastname: Berquist
authors.forename: John A
authors.initials: JA
authors.lastname: Kerner
mesh_terms: D000293:Adolescent; D000328:Adult; D055499:Catheter-Related Infections / Q000453:epidemiology / Q000517:prevention & control*; D002405:Catheterization, Central Venous / Q000009:adverse effects*; D002408:Catheters, Indwelling / Q000009:adverse effects*; D062905:Central Venous Catheters / Q000009:adverse effects*; D002648:Child; D002675:Child, Preschool; D000431:Ethanol; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D007223:Infant; D008297:Male; D010288:Parenteral Nutrition / Q000009:adverse effects / Q000379:methods*; D015995:Prevalence; D055815:Young Adult
chemical_list: D000431:Ethanol