30% Ethanol Locks Are Effective in Preventing Central Line-Associated Bloodstream Infections in Pediatric Intestinal Failure: A Pilot Study.

Abstract

Complications related to central venous lines (CVLs) are common in intestinal failure (IF), including central line-associated bloodstream infections (CLABSIs). Replacing heparin with 70% ethanol locks can reduce infection rates; however, concerns exist about potential negative effects on catheter integrity. We hypothesized that a lower ethanol concentration combined with citrate would prevent catheter-related complications, including CLABSIs. This was a retrospective cohort study in pediatric IF patients assessing rates of CLABSIs, catheter repair, catheter replacement, and thrombolytic (alteplase) use for suspected catheter-related thromboses comparing heparin, 70% ethanol, and 30% ethanol-2.8% citrate locks. Six patients were included with a total of 8777 catheter days. All patients utilized silicone single-lumen CVLs for venous access. The rate of CLABSIs was highest with heparin at 13.9 events per 1000 catheter days, which significantly dropped to 1.6 per 1000 catheter days on 70% ethanol (P=.02) and remained significantly low at 0.4 per 1000 catheter days when transitioning to 30% ethanol-2.8% citrate locks as compared with heparin (P=.01). No statistically significant differences were noted among the groups in rates of catheter repair and replacement and alteplase use. This pilot study provides supportive evidence that a lower ethanol lock concentration may be effective in maintaining a low rate of CLABSIs in pediatric IF patients using silicone CVLs. Although this study did not show significant positive impact on catheter integrity and durability, there are other potential benefits to using lower ethanol concentrations including reduced systemic ethanol exposure in children.