Ethanol-lock technique for persistent bacteremia of long-term intravascular devices in pediatric patients.

Abstract

OBJECTIVES:

To use the ethanol-lock technique (in conjunction with systemic antibiotics) to salvage central lines from removal and to prevent persistence of catheter-related infections among pediatric patients with long-term intravascular devices.

DESIGN:

Medical records of patients treated with ethanol locks were retrospectively reviewed from June 1, 2004, through June 22, 2005.

SETTING:

Childrens Hospital Los Angeles, Los Angeles, Calif, a tertiary care pediatric hospital. Patients Forty children with diverse underlying disorders were treated for 51 catheter-related infections using the Childrens Hospital Los Angeles ethanol-lock technique.

INTERVENTIONS:

Eligible infected central lines were instilled with a dose volume of 0.8 to 1.4 mL of 70% ethanol into the catheter lumen during 12 to 24 hours and then withdrawn. The volume of ethanol used was based on the type of intravascular device.

MAIN OUTCOME MEASURES:

Clearance of infection and incidence of recurrence.

RESULTS:

Of the 51 ethanol-lock treatments in 40 children, no catheters were removed because of persistent infection. Eighty-eight percent (45/51) of the treated episodes cleared without recurrence (defined as a relapse within 30 days with the same pathogen). Twelve (75%) of 16 polymicrobial isolates and 33 (94%) of 35 monomicrobial isolates were successfully treated. There were no adverse reactions or adverse effects reported.

CONCLUSION:

This retrospective study supports the use of the ethanol-lock technique in conjunction with systemic antibiotics as an effective and safe method to retain the use of a previously infected central venous catheter, decrease the need for line removal, and eradicate persistent pathogens in catheter-related infections.

• Authors: Wes Onland, Cathy E Shin, Stana Fustar, Teresa Rushing, Wing-Yen Wong
• Journal: Archives of pediatrics & adolescent medicine (Arch Pediatr Adolesc Med) Vol. 160 Issue 10 Pg. 1049-53 (Oct 2006) ISSN: 1072-4710 [Print] United States
• PMID: 17018464 (Publication Type: Journal Article)

Chemical References

• Anti-Infective Agents, Local
• Ethanol

Topics

• Adolescent
• Anti-Infective Agents, Local (administration & dosage)
• Bacteremia (drug therapy, etiology, microbiology)
• Catheterization, Central Venous (adverse effects)
• Catheters, Indwelling (microbiology)
• Child
• Child, Preschool
• Equipment Design
• Ethanol (administration & dosage)
• Female
• Humans
• Infant
• Male
• Retrospective Studies