Evaluation of Ethanol Lock Therapy in Pediatric Patients on Long-Term Parenteral Nutrition

• Published in: Nutrition in clinical practice Vol. 28; no. 2; pp. 226 - 231
• Main Authors: Pieroni, Kevin P., Nespor, Colleen, Ng, Marisa, Garcia, Manuel, Hurwitz, Melissa, Berquist, William E., Kerner, John A.
• Format: Journal Article
• Language: English
• Published: Los Angeles, CA SAGE Publications 01-04-2013
• Subjects: Adolescent; Adult; Catheter-Related Infections - epidemiology; Catheter-Related Infections - prevention & control; Catheterization, Central Venous - adverse effects; Catheters, Indwelling - adverse effects; catheter‐related infections; Central Venous Catheters - adverse effects; Child; Child, Preschool; Ethanol; Female; Follow-Up Studies; Humans; Infant; Male; Nursing; parenteral nutrition; Parenteral Nutrition - adverse effects; Parenteral Nutrition - methods; parenteral nutrition, home; Prevalence; Young Adult; parenteral nutrition, home; parenteral nutrition; catheter-related infections
• ISSN: 0884-5336; 1941-2452
• DOI: 10.1177/0884533612468009

Background: Pediatric home parenteral nutrition (PN) patients present a unique challenge with risks of catheter-associated bloodstream infections (CABSIs), sometimes requiring subsequent catheter removal. Recurrent infections can lead to line removal and potential loss of venous access in the future. Objective: Demonstrate that weekly ethanol lock therapy decreases CABSIs in long-term home PN patients and decreases line removals due to infections. Methods: Beginning August 2007, patients receiving PN with a history of multiple previous CABSIs were started on ethanol lock therapy. Seventy percent ethanol solution was instilled into the central venous catheter (CVC) for 2 hours weekly. Episodes of CABSIs and catheter removal due to infection were documented in patients prior to and after ethanol lock therapy. Results: Fourteen patients were followed for an average of 690 days after ethanol lock therapy was initiated. These patients were found to average 9.8 CABSIs per 1000 catheter days prior to starting ethanol lock therapy and only 2.7 CABSIs per 1000 catheter days after ethanol lock therapy (P < .001). Prior to ethanol lock therapy, the group averaged 4.3 catheter removals per 1000 catheter days but only 1.0 catheter removal per 1000 catheter days after ethanol lock therapy. Conclusion: Our group of patients showed a 73% reduction in CABSIs and a 77% reduction in catheter removal due to infection after ethanol lock therapy. In our patient population, weekly ethanol lock therapy for 2 hours is an effective technique to reduce CABSIs and catheter removal in long-term home PN patients.