Ethanol Lock Efficacy and Associated Complications in Children With Intestinal Failure

Abstract

Background Prophylactic ethanol lock therapy (ELT) reduces central line–associated bloodstream infections (CLA-BSIs) in children with intestinal failure (IF). However, the risk of associated complications is unclear. We aim to describe our experience with prophylactic ethanol locks in a cohort of patients with IF. Materials and Methods Thirty patients on ELT from 2010–2013 were identified by review of our intestinal rehabilitation registry. Patient demographics, CLA-BSI events, and line complications were extracted. Comparisons in infection and complication rates when on and off ELT were made using a Poisson mixed-effect regression model. Results CLA-BSIs when on and off ELT were 3.1 and 5.5 per 1000 catheter days, respectively (P < .015). Overall complication rates were similar in both groups. In those patients who experienced a complication, the complication rates on ELT compared with time off ELT were significantly lower (P < .003). Line perforation or breakage rates declined significantly when on ELT, from 1.8 to 1.53 per 1000 catheter days (P < .006). Line occlusion rates also decreased on ELT, from 0.6 to 0.3 per 1000 catheter days (P = .056). Infecting organisms were not different on and off ELT, and patients experienced a similar number of polymicrobial infections on or off therapy. Klebsiella pneumoniae was the most common infecting organism in both groups. Conclusions Ethanol lock therapy use reduces both CLA-BSI and central line complication rates in children with IF. These results underscore the safety and efficacy of ELT use in this population.

Nutrition Delivery and Growth Outcomes in Infants With Gastroschisis

“…Indeed, 23% of our cohort met the criteria for severe intestinal failure based on PN requirement for ≥90 days. CLABSI rates reported in pediatric intestinal failure, albeit among cohorts of older children, are in the similar range from 1.3 to 8.0 per 1000 catheter days . Among infants with short bowel syndrome, CLABSI was also reported to be associated with WAZ decline .…”

“…CLABSI rates reported in pediatric intestinal failure, albeit among cohorts of older children, are in the similar range from 1.3 to 8.0 per 1000 catheter days. 16,17 Among infants with short bowel syndrome, CLABSI was also reported to be associated with WAZ decline. 18 CLABSI prevention practices such as hand hygiene, optimal catheter site selection, sterile insertion, diligent maintenance including minimizing line entries, and minimizing central line days are frequently included in checklists and have been shown to decrease CLABSI rates in the NICU.…”

Central Venous Access in the Pediatric Population With Emphasis on Complications and Prevention Strategies

“…Ethanol lock therapy has also been proven to reduce CLABSI rates in children with intestinal failure 78 , 92 , 93 . Patients with intestinal failure caused by bowel resection have reduced intestinal absorption, resulting in nutrient, fluid, and electrolyte deficiencies coupled with dysmotility, increasing the risk of bacterial translocation into the bloodstream causing systemic infection.…”

Evidence‐Based Strategies and Recommendations for Preservation of Central Venous Access in Children

“…Evidence for prophylactic use of antimicrobial lock solutions has been encouraging in small samples . Meta‐analysis suggests they reduce infection risk and can be additive to other therapies, although support for ethanol lock therapy was equivocal in a recent double‐blind, placebo‐controlled RCT .…”

“…Evidence for prophylactic use of antimicrobial lock solutions has been encouraging in small samples. 74,[94][95][96][97][98] Meta-analysis suggests they reduce infection risk and can be additive to other therapies, 99,100 although support for ethanol lock therapy was equivocal in a recent double-blind, placebo-controlled RCT. 101 Similarly, evidence regarding heparin-bonded catheters in children remains too weak for a recommendation at this time.…”