In our hospital we routinely lock our silicone catheters with ethanol. The majority of silicone lines placed are the 6.6F SL and the 7F DL cuffed catheters. Occasionally teams other than our IR will place the smaller 4.2F lines. While I know that we can technically lock these lines with ethanol, we are hesitant to do so because of the smallness of the interlumen. These small lines are a challenge to maintain in general, let alone placing ethanol locks. We are concerned for occlusion and breakage.
What is everyone's practice concerning ethanol locking of the 4.2F catheters. Also, are there any ideas on how to maintain these lines for longer term use while preventing complications.
thank you
You will not find other hospitals routinely locking any VAD with an alternative locking solution. I am curious about how this decision was made. Alcohol acts as a solvent on some formulations of polyurethane, but this is not an issue with silicone. So if you are positive that you have a 4.2 F silicone catheter there is no problem. But if the 4.2 catheter or any other catheter is made of polyurethane then there could easily be some problems but it depends on the specific type of polyurethane and what that manufacturer says about this. What concentration of ethanol are you using? A solution greater than 30% presents more risk to polyurethane catheters. Also is the ethanol lock solution being aspriated out prior to each use? This is the INS SOP and the SHEA CLABSI Compendium guidelines. Also the ethanol lock needs to remain in the lumen for 20 hours to be effective. That makes it difficult to use the lumen for infusion.
Lynn Hadaway, M.Ed., RN, CRNI
Lynn Hadaway Associates, Inc.
PO Box 10
Milner, GA 30257
Website http://www.hadawayassociates.com
Office Phone 770-358-7861
Our hospital uses a 70% ethanol lock for antimicrobial therapy in line salvage of contaminated lines and prophalactically for lines of patients with history of CLABSI, high risk of CLABSI and our intestinal rehab patients (short gut). The majority of our lines for ethanol treatment are 6.6F and 7F silicone CVCs. An ethanol lock is only administered in silicone lines for times ranging 2 hours (line salvage) and 6 to 12 hours dependent upon therapies. While we do have a good response to the ethanol treatment with a decreased CLABSI rate, there is an increase risk of line complications such as thrombosis, line breakage,repair and replacement. I am enclosing an article that I found supporting this information. ( Ethanol Lock for Prevention of CVC-Related Bloodstream Infection in Pediatric Patients: A Systematic Review and meta-Analysis by Caroline M. Sierra et al. J Pediatr Pharmacol Ther.2023) I know that technically, a 4.2F silicone CVC line can have an ethanol lock - I have concerns of the complications of thrombosis, line breakage and replacement. We have difficulty maintaining these lines without complicatons due to their small interluminal diameter.
I was wondering two things: are other hospitals locking the 4.2F silicone CVC with the 70% ethanol, and if so how long. Also, what are people doing to help maintain the longevity of these lines.
Thank you for your response.
The cause of your prevalent problems is the 70% concentration of ethanol. Concentrations greater than 30% are associated with these problems. Where does this locking solution come from? Is your phamacy making it or is it obtained from an outside compounding pharmacy? ls this provided in prefilled syringes are multidose vials? There is no commercial ethanol solutions for locking VADs and it must be compounded and sterilized. Finally are you certain that excessive force is not being used when the patency is first assessed before each medication? There are many more issues involved than just the solution and the catheter.
Lynn Hadaway, M.Ed., RN, CRNI
Lynn Hadaway Associates, Inc.
PO Box 10
Milner, GA 30257
Website http://www.hadawayassociates.com
Office Phone 770-358-7861