Inhibition of heparin precipitation, bacterial growth, and fungal growth with a combined isopropanol–ethanol locking solution for vascular access devices

Restrepo, Daniel; Laconi, Nicholas; Alcantar, Norma; West, Leigh A.; Buttice, Audrey L.; Patel, Saumil; Kayton, Mark L.

doi:10.1016/j.jpedsurg.2014.07.003

Cited by 10 publications

(8 citation statements)

References 22 publications

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“…Occlusion has been attributed to ethanol interaction with plasma protein or heparin. Indeed, in vitro studies have confirmed that the commonly used ethanol concentration of 70% induces heparin precipitation 22 . In addition, plasma protein has been shown to aggregate in the presence of 70% ethanol 23 .…”

Section: Discussionmentioning

confidence: 93%

Ethanol Lock Efficacy and Associated Complications in Children With Intestinal Failure

Mezoff¹,

Lin

Troutt³

et al. 2015

J Parenter Enteral Nutr

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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.

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Section: Discussionmentioning

confidence: 93%

Ethanol Lock Efficacy and Associated Complications in Children With Intestinal Failure

Mezoff¹,

Lin

Troutt³

et al. 2015

J Parenter Enteral Nutr

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“…Usually, in the treatment of oncology patients, various drugs, including anti‐cancer agents are used, but the relationship between the anti‐cancer drugs and catheter blockage is not mentioned and, therefore, needs to be studied in the future. Another explanation was that catheter blockage was related to precipitate that formed when ethanol was exposed to residual heparin present in the catheter . This suggests that not only did heparin remain in the CVC, but also that the catheter‐bound heparin was still present.…”

Section: Discussionmentioning

confidence: 99%

Ethanol lock therapy in pediatric patients: A multicenter prospective study

Chiba

Yonekura

Kaji

et al. 2020

Pediatrics International

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Background Ethanol lock therapy (ELT) has been performed for the purpose of preserving central venous catheters (CVC) in central venous catheter‐related blood stream infection (CRBSI), but evidence for its effectiveness is not established. We conducted a multicenter, prospective study on the ELT protocol to ascertain its safety and effectiveness against CRBSI. Methods The subjects were patients aged over 1 year with potential for developing CRBSI who had long‐term indwelling silicone CVCs. After culturing the catheterized blood, a 70% ethanol lock was performed daily for 2–4 h for 7 days. The effectiveness rate of ELT for single and multiple courses, the presence or absence of relapse of CRBSI within 4 weeks of treatment, and whether the CVC could be salvaged after 4 weeks were examined. Results From September 2014 to August 2018, 49 cases from six hospitals were enrolled in the study. Catheter blockage was seen in one case and the CVC was removed. A single course of ELT was effective in episodes 88% (42/48). In the remaining three episodes that failed after a single course of ELT, a second ELT was performed; however, all were ineffective. In episodes 93% (40/42), no CRBSI relapse was seen up to 4 weeks after the end of treatment. In episodes 84% (41/49), the catheter could be preserved for 4 weeks or more after the end of treatment. Facial flushing was seen in two cases as an adverse event; however, this was transient and soon disappeared. Conclusion ELT is effective for 88% of CRBSI and 84% of catheters can be salvaged; therefore, this protocol is considered useful. Trial registration: UMIN000013677.

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“…We are aware that our study has some important limitations. First, the compatibility study was based on visual observations, which are less accurate than turbidimetry in measuring precipitation [ 51 ]. However, the visual observation approach is classically used to assess the solubility of antibiotics/UFH lock solutions [ 52 ] and the precipitation of protein in ethanol [ 48 ].…”

Section: Discussionmentioning

confidence: 99%

Compatibility of Injectable Anticoagulant Agents in Ethanol; In Vitro Antibiofilm Activity and Impact on Polyurethane Catheters of Enoxaparin 400 U/mL in 40% v/v Ethanol

Balestrino¹,

Quintana²,

Charbonnel³

et al. 2016

PLoS ONE

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Background and ObjectivesInterdialytic lock solutions should maintain catheter patency and prevent catheter infections. We aimed to determine in which conditions injectable anticoagulant agents (IAAs) combined with ethanol are compatible and to assess the antibiofilm activity of the selected combination and its effects on dialysis catheters (DC).MethodsThe solubility and compatibility of unfractionated heparin (UFH), low molecular weight heparins (LMWHs), heparinoids and fondaparinux (50 to 2,500 U/mL) in 30 to 70% ethanol were determined by visual observation. The stability of enoxaparin in ethanol and the ethanol content were assessed by high performance liquid chromatography (HPLC) and titrimetric control, respectively. The bactericidal effect was determined on 24h-old biofilms embedded in silicone-DC. The integrity of polyurethane-DC immersed in anticoagulant-ethanol was assessed by gas chromatography-mass spectrometry (GC-MS) and compared with previously published results.ResultsThe compatibility of IAAs and ethanol varied according to IAA type and concentration, and ethanol content. UFH in 40% ethanol was not compatible, whatever the UFH concentration used. Established limits of compatibility of enoxaparin, nadroparin, dalteparin and tinzaparin in 40% ethanol were 1350, 575, 307 and 207 U/ml, respectively, and up to 300 U/ml for danaparoid and 1 mg/mL for fondaparinux. Enoxaparin 400 U/mL in 40% ethanol (Enox/Eth) eradicated biofilm after 4 hours of exposure for Staphylococcus epidermidis, Pseudomonas aeruginosa and Candida albicans and after 24 hours for Klebsiella pneumoniae and S. aureus. Aliphatic carbonate and alcohol compounds were released by polyurethane-DC after Enox/Eth exposure, as after 40% ethanol or saline exposure. There was no significant difference between the amounts released after 30 minutes of exposure to Enox/Eth and 15 days to saline.ConclusionsA 40% ethanol solution can be combined with all IAAs but UFH. Enox/Eth was effective as an anti-biofilm agent with minor impacts on DC integrity and could be a useful interdialytic lock solution.

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Inhibition of heparin precipitation, bacterial growth, and fungal growth with a combined isopropanol–ethanol locking solution for vascular access devices

Cited by 10 publications

References 22 publications

Ethanol Lock Efficacy and Associated Complications in Children With Intestinal Failure

Ethanol Lock Efficacy and Associated Complications in Children With Intestinal Failure

Ethanol lock therapy in pediatric patients: A multicenter prospective study

Compatibility of Injectable Anticoagulant Agents in Ethanol; In Vitro Antibiofilm Activity and Impact on Polyurethane Catheters of Enoxaparin 400 U/mL in 40% v/v Ethanol

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