Ethanol Lock Technique: Review of the Literature

Abstract

Central venous catheters (CVCs) are commonly used among adult and pediatric patients for administration of fluids, medications, and nutrition. Central line-associated (CLA) bloodstream infection (BSI) is a serious complication following CVC insertion. The aim of this review is to summarize available data regarding the ethanol lock technique, which is a proposed method for sterilizing the lumen of the catheter by instilling an ethanol solution and allowing it to dwell in the catheter for a certain amount of time. Studies on ethanol lock technique differ in ethanol concentrations, luminal dwell times, catheter types, inclusion of anticoagulants, use of systemic antibiotics, and use of the technique for prevention or for treatment of CLA BSI. In vitro studies demonstrate the efficacy of ethanol in the eradication of various pathogens. Definitive catheter integrity data are limited. Clinical trials report tolerable adverse events with ethanol locks, as well as encouraging results for prevention and treatment of CLA BSI.

Reducing Catheter-Related Infections in Hemodialysis Patients

“…Hemmelgarn et al reported successful reduction in CRBSI with the use of once-weekly tissue plasminogen activator, but the longterm cost of this strategy is prohibitive (32). Ethanol locking solutions are effective sterilizing agents for CRBSI prophylaxis, as well as for salvage in silicone-based central venous catheters of oncology patients and pediatric patients receiving parenteral nutrition (33). However, safety of ethanol in polyurethane-based hemodialysis catheters has been an ongoing concern.…”

Locking of Tunneled Cuffed Hemodialysis Catheters with a Mixture of 45% Ethanol and 4% Trisodium Citrate is Effective in Preventing Catheter-Related Infections and Thrombosis

“…Resistance to the bactericidal effect does not develop because it exerts its effect via nonspecific protein denaturation in the cell wall of the microorganism (27). Thirty percent and higher concentrations of ethanol show a bactericidal effect on S. aureus (26).…”

“…Ethanol is a cheap, broad-spectrum antiseptic and disinfectant agent and has bactericidal effect for both Gram-positive and Gramnegative organisms as well as a fungicidal effect (26). Resistance to the bactericidal effect does not develop because it exerts its effect via nonspecific protein denaturation in the cell wall of the microorganism (27).…”

Efecto Antimicrobiano del Aceite Esencial de Canela (Cinnamomum zeylanicum) sobre Cepas de Salmonella

“…Se realizaron 5 diluciones: 10, 30, 50, 70 y 90% (v/v) con etanol al 25% (Maiefski et al, 2009). Se transfirió 1 ml del inóculo estandarizado más 1 ml de las cinco concentraciones del aceite esencial de canela de cada una de las cepas y se incubaron a 37 °C durante 24 h, estableciendo la concentración mínima inhibitoria (CMI).…”