title: Therapeutic and prophylactic ethanol lock therapy in patients with bleeding disorders.
abstract: Obtaining a reliable venous access is a limiting factor for early initiation of clotting factor prophylaxis and immune tolerance induction. To circumvent this issue, central venous access devices (CVADs) are increasingly being used. Catheter-related infections (CRIs) remain the primary complication of insertion of CVAD. Thus, newer strategies for treatment and prevention of CRI are needed. Ethanol lock therapy (ELT) has been used to treat and prevent CRI in non-bleeding disorder patients. The aim of this study was to assess the efficacy of ELT in treating and preventing CRI in bleeding disorder patients. The medical charts of patients with bleeding disorders who underwent ELT for antimicrobial resistant CRIs were reviewed and data were analysed. ELT was effective in catheter salvage in 87% of patients with antimicrobial resistant CRI by a wide variety of pathogens. Prophylactic therapy with ethanol lock was associated with catheter dysfunction especially in mediports. ELT should be considered prior to removal of catheters in bleeding disorder patients with resistant CRIs. Further studies are needed for using prophylactic ethanol lock in prevention of CRIs in bleeding disorder patients.
authors.affiliation: Division of Haematology and Oncology, Carman and Ann Adams Department of Pediatrics, Children's Hospital of Michigan, Detroit, MI, USA; Wayne State University, Detroit, MI, USA.
authors.forename: M
authors.initials: M
authors.lastname: Rajpurkar
authors.forename: E
authors.initials: E
authors.lastname: McGrath
authors.forename: J
authors.initials: J
authors.lastname: Joyce
authors.forename: K
authors.initials: K
authors.lastname: Boldt-MacDonald
authors.forename: M
authors.initials: M
authors.lastname: Chitlur
authors.forename: J
authors.initials: J
authors.lastname: Lusher
mesh_terms: D000890:Anti-Infective Agents / Q000008:administration & dosage*; D019072:Antibiotic Prophylaxis; D001778:Blood Coagulation Disorders / Q000150:complications* / Q000175:diagnosis; D055499:Catheter-Related Infections / Q000188:drug therapy* / Q000209:etiology* / Q000517:prevention & control; D002408:Catheters, Indwelling / Q000009:adverse effects; D000431:Ethanol / Q000008:administration & dosage*; D006801:Humans; D008297:Male; D016896:Treatment Outcome
chemical_list: D000890:Anti-Infective Agents; D000431:Ethanol
keywords: bleeding disorders; catheter-related infections; ethanol lock