I have been working on writing a ethanol lock policy and I am seeing differing data regarding whether to withdraw the ethanol or to push it through. I was wondering if anyone has experience with this and any articles to back it up?
I have been working on writing a ethanol lock policy and I am seeing differing data regarding whether to withdraw the ethanol or to push it through. I was wondering if anyone has experience with this and any articles to back it up?
You might try Gail Sansivero in New York , I cant find her email but she gave me all the info for abx lock and ethanol lock years ago
Ethanlol is an off label to be used as a locking solution in the United States. Since ethanol is likely batched or aliqoted by pharmacy for this purpose of off label usage I suggest speaking with your pharmacist to write your policy and procuedure. The pharmacist is an expert at compounds and medications and their adverse events or contraindications.
You may also want to review all of the catheters you are looking at locking and speak to the clinical resource hotlines of all those companies for guidance on locking and their own labeled usage
kathy Kokotis
PICC Business Analyst
Here is a reference from the University of Nebraska Medical Center
Ethanol Lock Technique for Prevention and Treatment of Central line-Associated Bloodstream Infections( CLA-BSIs)
Bill Anderson
Excelsior Medical
I am giving a presentation at AVA on this topic - Catheter Locking Solutions: Alternatives to Heparin. While Kathy is technically correct about this being an off-label use, I can not imagine any alcohol company going to do the research to make this a labeled indication. The Nebraska site already listed is an excellent resource. This product along with any of the other alternative solutions must be obtained from a compounding pharmacy. They start off with non-sterile products can make a sterile product. There are strict rules for how compounding is done and not all pharmacies or pharmacists are up to speed on these requirements. If you do decide to go this route, make sure you are dealing with a reputable compounding pharmacy. There are no alternative solutions available in the USA in a prefilled syringe already prepared to use. These products are available in other countries but the FDA has not cleared any for use in the USA yet. So a compounding pharmacy is your only alternative. 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
there is a clinical trial currently underway for labeling for dialysis catheters on the clinical trial research site
kathy
Thank you for all of the data I really appreciate it and we would be compunding the lock solution out of our home infusion pharmacy. My main question is whether to withdraw the ethanol prior to the next infusion. I have some articles that state that it is now safe to flush the ethanol through. Does anyone have any information on this? Thanks, Brooke
Brooke Thompson
What concentration are you using? Ethanol is used as an infusion for several clinical indications, so I would say it is acceptable to flush it through. I hate the idea of trying to get all nurses to withdraw the lock solution. If you are using a higher concentration, the patient may have some side effects like they have when they drink alcohol. 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
Since ethanol locking is still an off-label indication there is no standard protocol that defines the optimal concentration, volume required (relative to the lumen volume), dwell time, lock frequency and whether to flush or lock. We have developed a 30% ethanol with 4% citrate product for Canada and Europe. I'd be glad to get you in touch with our Medical Director to discuss the published literature as well as our findings on these parameters. We can also get you in touch with clinicians that are flushing the ethanol lock and clinicians that are aspirating the lock so you can get their experiences.
Best Regards,
Bill Anderson
[email protected]
Excelsior Medical
www.excelsiormedical.com
www.swabcap.com