Can anyone give me information on using an Ethanol lock on a central line? It is really strange, but I heard of a pt in the hospital just now at nutritional support meeting, and coming back to the office after that meeting, I had a Home Care RN ask me about the same thing on a patient of hers!!! I have (a number of years ago) used it for lipid sludge in a Hickman, but have not yet heard of using it as a lock. In the 2nd case, the MD wants to use it daily as a lock solution AFTER the patients antibiotic therapy iis completed.
In the first case the doc is using it because this is the pts last place for a central line and the doc is trying to keep the line. That is what the pt told the pharmacist.
Anything you can share will be appreciated. Thanks!!
Ann
This is becoming more common in practice. There are several articles published about its use as a lock solution. However it is not available as a commercial product in the US in a prefilled syringe or even with a labeled indication for locking catheters. You will need to get this from a compounding pharmacy in a sterile solution. Lynn
Lynn Hadaway, M.Ed., RN, NPD-BC, CRNI
Lynn Hadaway Associates, Inc.
PO Box 10
Milner, GA 30257
Website http://www.hadawayassociates.com
Office Phone 770-358-7861
Thanks Lynn. Yes, our pharmacy made it years past, so they would probably do this. Do you have references to the articles?
Thanks so much for all your help!!
We've used ethanol 70% locks for a few high risk home parenteral nutrition clients for a few years now successfully. The clients instill the ethanol, using the prefilled syringe, in the am after flushing the catheter with NS upon completion of the night PN. The solution is left indwelling for ~ 12 hrs and is then either flushed through or aspirated from the catheter before hooking up the next night. You'll need to confirm with the manufacturer that the catheter material is compatible with the solution. Here's a list of references (sorry I tried, unsuccessfully, to post it as an attachment).
Daphne Broadhurst RN
Desjardins Pharmacy, Ottawa ON
ETHANOL References
1. Rajpurkar M, Boldt-Macdonald K, McLenon R, et al.Ethanol lock therapy for the treatment of catheter-related infections in haemophilia patients Haemophilia. 2009 Jul 29
3. Balestrino D, Souweine B. Charbonnel N et al. Eradication of microorganisms embedded in biofilm by an ethanol-based solution. Nephrol Dial Transplant. 2009; Apr 21
4. Maiefski M, Rupp ME, Hermsen ED. Ethanol lock technique: review of the literature. Infect Control Hosp Epidemiol. 2009; 30(1):1096-108.
5. Onland W et al. Ethanol-lock technique for persistent bacteremia of long-term intravascular devices in pediatric patients. Arch Pediatr Adolesc Med 2006; 160:1049–1053.
6. Institute for Healthcare Improvement (IHI). 5 million lives campaign: How to guide: Prevent central line infections 2007. Accessed at www.ihi.org/IHI/Programs/Campaign
7. Pennington CR, Pithie AD. Ethanol lock in the management of catheter occlusion. J Parenter Enter Nutr 1987; 11: 507–508
8. Johnston DA et al. Ethanol flush for the prevention occlusion of catheter. Clinical Nutrition 2002;11: 97-100
9. Centers for Disease Control and Prevention. Guidelines for the prevention of intravascular catheter-related infections. MMWR 2002;51(RR-10):[inclusive page numbers].
10. Ball PA et al. Ethanol locking as a possible treatment for microbial contamination of long-term central venous catheters. Nutrition 2003; 19: 570
11. Dannenberg C et al. Ethanol-lock technique in the treatment of bloodstream infections in pediatric oncology patients with broviac catheter. J Pediatr Hematol Oncol 2003; 5: 616-621
12. Broom J et al. Ethanol lock therapy to treat central venous catheter-associated blood stream infections: results from a prospective trial. Scand J Infect Dis 2008; 40(5): 399-406
13. Ackoundou-N’guessan C et al. Ethanol lock solution as an adjunct treatment for preventing recurrent catheter-related sepsis—first case report in dialysis setting. Nephrol Dial Transplant 2006; 21: 3339
14. Metcalf S et al. Use of ethanol locks to prevent recurrent central line sepsis. Journal of Infection 2004; 49: 20–22
15. Opilla MT, Kirby DF, Edmond MB. Use of ethanol lock therapy to reduce the incidence of catheter-related bloodstream infections in home parenteral nutrition patients. JPEN 2007; 31(4): 302-305
16. Lairda, J et al. Complications of the ethanol-lock technique in the treatment of central venous catheter sepsis Journal of Infection 2005; 51: 338–341
17. Cober MP, Johnson CE. Stability of 70% alcohol solutions in polypropylene syringes for use in ethanol-lock therapy. Am J Health Syst Pharm 2007; 64 (23): 2480-2
18. Pomplun M et al. Stability of a heparin-free 50% ethanol lock solution for central venous catheters. J Oncol Pharm Pract 2007;13 (1): 33-7
19. Crnich M et al. The effects of prolonged ethanol exposure on the mechanical properties of polyurethane and silicone catheters used for intravascular access. Infect Control Hosp Epidemiol 2005; 26: 708-714
20. Guenu S et al. Mass spectrometry and scanning electron microscopy study of silicone tunneled dialysis catheter integrity after an exposure of 15 days to 60% ethanol solution. Rapid Commun Mass Spectom 2007; 21(2): 229-36
21. Bell AL. et al. Ethanol/trisodium citrate for hemodialysis catheter lock. Clinical Nephrology 2004; 62 (5): 369-73
22. Takla TA, Zelenitsky SA, Vercaigne LM Effect of ethanol/trisodium citrate lock on microorganisms causing hemodialysis catheter-related infections. Scand J Infect Dis. 2008; 40 (5): 399-406
23. Raad I et al. Optimal antimicrobial catheter lock solution, using different combinations of minocycline, EDTA, and 25-percent ethanol, rapidly eradicates organisms embedded in biofilm. Antimicrobial Agents and Chemotherapy Jan. 2007: 78–83
Daphne Broadhurst
Desjardins Pharmacy
Ottawa, Canada
Ann
We are using Ethanol Lok here - have for a year or two - give me a call and I can put you/your pharmacist in touch with mine
Ann Marie
[email protected]
570-271-5555 ext 54784
Ann Marie Parry, RN, CRNI, VA-BC
[email protected]