title: Effects of prolonged ethanol lock exposure to carbothane- and silicone-based hemodialysis catheters: a 26-week study.
abstract: OBJECTIVE
  Antibiotic locks in catheter-dependent chronic hemodialysis patients reduce the rate of catheter-related bloodstream infections (CRBSIs), but may be associated with the development of resistant bacteria. Ethanol-based catheter locks may provide a better alternative; however, there are limited data on the long-term integrity of dialysis catheters exposed to ethanol.
  
  
  METHODS
  We performed in vitro testing of two types of hemodialysis catheters—silicone (SLC) and carbothane (CBT) based—with a 70% ethanol lock (EL) versus heparin lock (HL) for 26 weeks. Lock solutions were changed thrice weekly to mimic a conventional hemodialysis schedule. We tested mechanical properties of the catheters at 0, 13 and 26 weeks by examining stress/strain relationships (SS400%) and modulus of elasticity (ME). Electron microscopy was performed to examine catheter ultrastructure at 0 and 26 weeks.
  
  
  RESULTS
  Catheter integrity for HL versus EL in SLC (SS400%: 4.5 vs. 4.5 MPa, p = NS; ME: 4.6 vs. 4.7 MPa, p = NS) or CBT-based catheters (SS400%: 7.6 vs. 8.9 MPa, p = NS; ME: 9.6 vs. 12.2 MPa, p = NS) were all similar at 13 and 26 weeks. Scanning electron microscopy revealed no structural changes in the central and luminal wall internal surfaces of EL- versus HL-treated catheters.
  
  
  CONCLUSIONS
  There were no significant differences in catheter integrity between SLC or CBT catheters exposed to a 70% EL for 26 weeks. Given its low cost, potential to avoid antibiotic resistance and structural integrity after 6 months of high-dose ethanol, ELs should be studied prospectively against antibiotic locks to assess the efficacy and safety in hemodialysis patients.
authors.affiliation: 2 Tufts University School of Medicine, Boston, MA - USA.
authors.forename: Daniel L
authors.initials: DL
authors.lastname: Landry
authors.forename: Randa A
authors.initials: RA
authors.lastname: Jaber
authors.forename: Nandheesha
authors.initials: N
authors.lastname: Hanumanthappa
authors.forename: George S
authors.initials: GS
authors.lastname: Lipkowitz
authors.forename: Michael H
authors.initials: MH
authors.lastname: O'Shea
authors.forename: Harry
authors.initials: H
authors.lastname: Bermudez
authors.forename: Adam P
authors.initials: AP
authors.lastname: Hathorne
authors.forename: Gregory L
authors.initials: GL
authors.lastname: Braden
mesh_terms: D000900:Anti-Bacterial Agents / Q000627:therapeutic use; D000891:Anti-Infective Agents, Local / Q000737:chemistry* / Q000627:therapeutic use; D000925:Anticoagulants / Q000737:chemistry; D055499:Catheter-Related Infections / Q000382:microbiology / Q000517:prevention & control; D002408:Catheters, Indwelling / Q000009:adverse effects; D055119:Elastic Modulus; D019544:Equipment Failure Analysis; D000431:Ethanol / Q000737:chemistry* / Q000627:therapeutic use; D006493:Heparin / Q000737:chemistry; D008422:Materials Testing; D011474:Prosthesis Design; D011475:Prosthesis Failure; D006435:Renal Dialysis / Q000009:adverse effects / Q000295:instrumentation*; D012828:Silicones / Q000737:chemistry*; D013314:Stress, Mechanical; D013997:Time Factors; D062666:Vascular Access Devices / Q000009:adverse effects
chemical_list: D000900:Anti-Bacterial Agents; D000891:Anti-Infective Agents, Local; D000925:Anticoagulants; D012828:Silicones; D000431:Ethanol; D006493:Heparin