Does anyone have info or protocols for Ethanol locking a central line. I have the info on vanco locking but the Infectious disease MD said that vanco wont be effective for it. The pt has had multiple line and all but one have gotten infected over the past year or two.
I have a home parenteral nutrition patient who has been self-administering 3 mL 70% Ethanol lock qam via a Hickman single lumen catheter, upon completion of her HPN daily. The syringes are prepared under a laminar flow hood by pharmacy & delivered on a weekly basis & refrigerated. Studies cite aspiration of ethanol prior to use of line while others flush it through. In an effort to minimize use of her line, the pt flushes her through. Recurrent line sepsis & hence line replacement precipitated this in an effort to prevent infection & preserve her veins. She has been administering Ethanol lock x ~ 4 months & I'm thrilled to say still infection-free since starting. Reported side effects in the literature include fatigue, lightheadedness & nausea, although our pt. has noted no adverse effects. Prior to initiation, I verified with the manufacturer that the silicone Hickman's integrity would not be altered by the Ethanol. Interestingly, the client has not heparinized her Hickman (split septum cap) in 4 months & no signs of occlusion.
Daphne B.
Ottawa, CA
References:
Opilla T et al. Use of ethanol lock therapy to reduce the incidence of catheter-related bloodstream infections in home parenteral nutrition patients. Journal of Parenteral & Enteral Nutrition. 2007; 31 (4): 302-305.
Onland W, Shin CE, Fustar S, et al. Ethanol-lock technique for persistent bacteremia of long-term intravascular devices in pediatric patients. Arch Pediatr Adolesc Med 2006; 160:1049–1053
Ackoundou. 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
Crnich C et al. The effects of prolonged ethanol exposure on the mechanical properties of polyurethane and silicone catheters used for intravscular access. Infect Control Hosp Epidemiol. 2005; 26:708-714.
Lairda, J, Soutara, R Complications of the ethanol-lock technique in the treatment of central venous catheter sepsis. Journal of Infection (2005) 51, 338–341Metcalf S et al. Use of ethanol locks to prevent recurrent central line sepsis. J Infect. 2004; 49:20-22
Dannenberg et al. Ethanol-lock technique in the treatment of bloodstream infections in pediatric oncology patients with Broviac catheter. J Pediatr Hematol Oncol. 2003;25:616-621
Ball P et al. Ethanol locking as a possible treatmetn for microbial contamination of long-term central venous catheters. Nutrition. 2003. 19:570
Daphne Broadhurst
Desjardins Pharmacy
Ottawa, Canada