Does anybody do antibiotic locking. Our facility does not as there has not been any persistent line infections with longterm catheters. However, there is a patient that has had a tunnelled Hickman catheter for approx 7 yrs for longterm TPN and has had routine infections and changes of catheter to treat these infections. MDs are now considering antibiotic locking. Does anyone have any information about how to do this, how often and for how long. Also whether ethanol locking can play any roll longterm in prevention or these chronic infections.
Any advise or reference would be appreciated,
Thank you,
SOD
I believe any antibiotic locking of a catheter would be considered off label use of both the antibiotic solution and the catheter. I don't believe the FDA has cleard any antibiotics or locking solutions for use in dweliing in the US, and I believe most if not all catheter companies in their instructions for use state the cathether needs to be flushed with NS, and/or Heparinized saline, and none currently state the use of ethanols or antibiotics for locking is approved for their products.
Keep in mind, many drugs and products are used off label every day in order to do what is best for the patient and provide best outcomes, however that does shift the liability of poor outcomes to the clinician makeing the decistion to use something in an off label fashion.
Antibiotic and Ethanol locks are more common in Europe, so a literature search including British and European publications may provide some insight into successful solutions and protocols.
Chris Cavanaugh, RN, BSN, CRNI, VA-BC
ABX locking is a method recommended by IDSA and CDC to prevent removal of critical long term CVADs when the patient can not manage without them and there are limited or no other sites for removal and insertion of a new CVAD. This depends upon the specific organism cultured from the CVAD. Follow the recommendations in this document
1. Mermel LA, Allon M, Bouza E, et al. Clinical Practice Guidelines for the Diagnosis and Management of Intravascular Catheter‚ÄêRelated Infection: 2009 Update by the Infectious Diseases Society of America. Clinical Infectious Diseases. 2009;49(1):1-45.
ABX locks are only recommended for the salvage of CVADs and not for routine prophylactic locking. These must be prepared by a compounding pharmacy and none are commercially available in the USA,
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