Ethanol locks for the prevention of catheter-related infection in patients with central venous catheter: A systematic review and meta-analysis of randomized controlled trials.

Jun Zhang,Bo Wang,Jinxia Wang,Qin Yang,Raffaele Serra

doi:10.1371/journal.pone.0222408

Abstract

BackgroundThe widespread use of central venous catheters (CVCs) has exposed patients to a high risk of catheter-related infection (CRI), which is linked to substantial morbidity and mortality. Several strategies for preventing CRI, including ethanol lock prophylaxis, have been explored. This study aimed to provide a comprehensive summary of randomized controlled trials (RCTs) assessing the efficacy and safety of ethanol locks for preventing CRI in patients with CVC.MethodsWe searched six electronic databases, earlier relevant meta-analyses and the reference lists of the included studies for RCTs that assessed the effects of ethanol locks on CRI in patients with CVC versus a control group. Two authors independently assessed the methodological quality of the included studies using the Cochrane Risk of Bias tool and extracted relevant information according to a predesigned extraction form. Data were analyzed using the Cochrane Collaboration’s RevMan 5.3.ResultsNine studies involving 2451 patients were included. Although limited in power, the results of the meta-analysis indicated a positive effect of ethanol lock prophylaxis on reducing catheter-related bloodstream infection (CRBSI) compared to heparin alone [OR = 0.53, 95% CI 0.34, 0.82, P = 0.004]. The effects on other outcomes, such as exit site infection, catheter dysfunction, catheter removal, thrombosis and mortality, were not statistically significant (P > 0.05). Moreover, although the effect of ethanol on CRBSI was in the expected direction compared to 0.9% NaCl locks, this effect was not statistically significant (P > 0.05).ConclusionsThe present data indicate that ethanol lock prophylaxis is a potential candidate for the prevention of CRBSI in patients with CVC. However, more attention should be paid to the uniform ethanol lock procedure and toxic effects after long-term ethanol lock exposure.

Highlights

Central venous catheter (CVC) is an indispensable lifesaving intervention for critically ill adults and pediatric patients requiring treatments such as chemotherapy, parenteral alimentation, hemodialysis and treatment for hematological malignancies
The widespread use of central venous catheters (CVCs) has exposed patients to a high risk of catheter-related infection (CRI), which is linked to substantial morbidity and mortality
The results of the meta-analysis indicated a positive effect of ethanol lock prophylaxis on reducing catheter-related bloodstream infection (CRBSI) compared to heparin alone [odds ratio (OR) = 0.53, 95% confidence interval (CI) 0.34, 0.82, P = 0.004]

Summary

Introduction

Central venous catheter (CVC) is an indispensable lifesaving intervention for critically ill adults and pediatric patients requiring treatments such as chemotherapy, parenteral alimentation, hemodialysis and treatment for hematological malignancies. The widespread use of CVC exposes patients to a high risk of catheter-related infection (CRI), which includes catheterrelated bloodstream infection (CRBSI) and exit site infection. As reported in the literature, 10% to 20% of tunneled catheters become infected in patients receiving chemotherapy for hematological malignancy[1,2]. The widespread use of central venous catheters (CVCs) has exposed patients to a high risk of catheter-related infection (CRI), which is linked to substantial morbidity and mortality. This study aimed to provide a comprehensive summary of randomized controlled trials (RCTs) assessing the efficacy and safety of ethanol locks for preventing CRI in patients with CVC

Objectives

Methods

Results