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jadahl
alcohol lock for CVAD's
Our Infection control MD is considering the use of alcohol locking CVAD's for infection control.  I have of course, heard of antibiotic locking lines, but not alcohol.  I am not finding any information on the topic.  Does anyone know anything about this practice?????Any information would be greatly appreciated.  Jane Dahl, ANM Vascular Access Nursing, Salem Hospital, Salem Or.
lynncrni
The use of ethanol has been

The use of ethanol has been used to treat an infected CVC with good success. Are you talking about routine use by locking all catheters with ethanol? I am not aware of any publications on using it for this purpose but it has been used and published for therapeutic use to salvage an infected catheter.

Lynn Hadaway, M.Ed., RN, BC, CRNI

www.hadawayassociates.com

Lynn Hadaway, M.Ed., NPD-BC, CRNI

Lynn Hadaway Associates, Inc.

PO Box 10

Milner, GA 30257

Website http://www.hadawayassociates.com

Office Phone 770-358-7861

Daphne Broadhurst
A year & a half ago, I had

A year & a half ago, I had a home tpn patient with +++ recurrent line sepsis, despite multiple teaching endeavours. Convinced that she wouldn't live to see her 20ish birthday due to these infections, I recommended (after an extensive literature search for various solutions) an ethanol lock q am post- tpn disconnect. I am thrilled to say she has now survived over a year without 1 line infection and I am convinced it's the ethanol. The pt. instills 2mL 70% Ethanol (prepared by our local pharmacy in pre-filled syringes) q am post-NS flush and leaves it indwelling until hook-up in the evening.

Some centers recommend extracting the Ethanol prior to flushing the line; however other studies just flushed it through (which is what this pt. does to reduce line manipulation). There are several studies (albeit no large randomized clinical trials) listed below that demonstrate the efficacy of ethanol in catheter-related blood stream infection prophylaxis. The optimal concentration of Ethanol has not yet been established. Studies demonstrate Ethanol concentrations from 35%-100% with reported side effects being minor (i.e., nausea, headache) & no serum enzyme changes.

One word of caution- you need to check with your device manufacturer to confirm the catheter is alcohol-compatible (silicone is alcohol resistant). As well, there are no commercially-prepared ethanol pre-filled syringes as far as I'm aware.

Hope this helps,
Daphne

Ethanol references:  

Ball, P et al. Ethanol locking as a possible treatment for microbial contamination of long-term central venous catheters. Nutrition. 2003; 19: 570 

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 

Pennington CR, Pithie AD. Ethanol lock in the management of catheter occlusion. J Parenter Enter Nutr 1987; 11:507–508. 

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. 

Johnston DA et al. Ethanol flush for the prevention occlusion of catheter. Clinical Nulrifion (2002) 11: 97-100 

Kerner JT, Garcia-Careaga, M et al. Treatment of catheter occlusion in pediatric pts  JPEN 2006;30(1):S73-S81 

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 M et all. 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). 

Bell AL et al. Ethanol/Trisodium citrate for hemodialysis catheter lock. Clinical Nephrology 2004;62(5): 369-373 

Metcalf S et al.Use of ethanol locks to prevent recurrent central line sepsis. Journal of Infection (2004) 49, 20–22 

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  

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, p. 78–83    

Daphne Broadhurst
Desjardins Pharmacy
Ottawa, Canada

Terry Hall
Do you know the cost of the
Do you know the cost of the ethanol flush and are you able to obtain reimbursement for the cost of the flush? If so, how is it billed? As an anti-infective? Terry Hall,RN,CRNI
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