Abstract | OBJECTIVE: METHODS: Plasma samples were exposed in-vitro to ethanol (concentrations ranging from 7 to 70 v/v%) and heparin lock solutions. In catheter studies designed to mimic different in-vivo situations, the catheter tip was placed in a plasma reservoir and the material contained within the catheter was analyzed after ethanol lock instillation. The samples underwent standardized investigation for protein precipitation. RESULTS:
Protein precipitation was observed in plasma samples containing ethanol solutions above a concentration of 28%, as well as in material retrieved from vertically positioned femoral catheters and jugular (subclavian) catheters simulating recumbent or head down tilt body positions. Precipitates could not be re-dissolved by dilution with plasma, urokinase or alteplase. Plasma samples containing heparin lock solutions showed no signs of precipitation. CONCLUSIONS: Our in-vitro results demonstrate that ethanol locks may be associated with plasma protein precipitation in central venous catheters. This phenomenon could be related to occlusion of vascular access devices locked with ethanol, as has been reported. Concerns should be raised regarding possible complications upon injection or spontaneous gravity induced leakage of such irreversibly precipitated protein particles into the systemic circulation. We suggest limiting the maximum advisable concentration of ethanol to 28 v/v% in catheter lock solutions.
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Authors | Gernot Schilcher, Axel Schlagenhauf, Daniel Schneditz, Hubert Scharnagl, Werner Ribitsch, Robert Krause, Alexander R Rosenkranz, Tatjana Stojakovic, Joerg H Horina |
Journal | PloS one
(PLoS One)
Vol. 8
Issue 12
Pg. e84869
( 2013)
ISSN: 1932-6203 [Electronic] United States |
PMID | 24391979
(Publication Type: Journal Article)
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Chemical References |
- Anti-Infective Agents, Local
- Blood Proteins
- Ethanol
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Topics |
- Anti-Infective Agents, Local
(adverse effects, therapeutic use)
- Blood Proteins
(metabolism)
- Catheter-Related Infections
(prevention & control)
- Central Venous Catheters
(microbiology)
- Chemical Precipitation
(drug effects)
- Ethanol
(adverse effects, therapeutic use)
- Hemorheology
- Humans
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