Prolonged Use of Ethanol Lock Prophylaxis With Polyurethane Catheters in Children With Intestinal Failure: A Single‐Center Experience

Abstract

Background: Children with intestinal failure (IF) receiving home parenteral nutrition (HPN) require long-term central venous catheters (CVCs). Ethanol lock prophylaxis (ELP) can reduce central line-associated bloodstream infections, but there are some concerns of increased breakage rates when used with polyurethane catheters. We reviewed our experience using ethanol locks in both polyurethane and silicone CVCs. Methods: A 10-year retrospective study of children with IF receiving HPN that used ELP was conducted. Complications per 1000 catheter days were extracted and a multivariable, mixed-effects Poisson model was used to compare catheter breakage rates and other complications between polyurethane and silicone CVCs. Results: A total of 10 patients were included, comprising 85 CVCs and 13,227 catheter days. The most common cause of IF was necrotizing enterocolitis. Breakages were the most common complication: polyurethane 1.46/1000 vs silicone 3.76/1000 catheter days. Silicone catheters had a significantly higher breakage rate (adjusted rate ratio [RR], 2.86; 95% confidence interval [CI], 2.84-2.88; P < .001) whereas polyurethane catheters had higher rates of occlusion (adjusted RR, 0.14; 95% CI, 0.07-0.28; P < .001) and displacements. However, there were no differences in the overall catheter replacement rates and any other catheter-related outcomes. Conclusions: In children with IF receiving long-term HPN, the use of ELP in polyurethane catheters was associated with a lower risk of breakages when compared with silicone CVCs. These results should be regarded as preliminary data, and further studies with a higher number of participants are necessary to provide a better level of evidence.

Safety and Efficacy of Ethanol for Catheter Salvage and Central Line-Associated Bloodstream Infection Prophylaxis in Polyurethane Catheters in the PICU

“…One of the first populations evaluated with ELT was children with intestinal failure, a specific group of patients with a high risk of infection, morbidity, and mortality. A regimen of ethanol prophylaxis three to seven times per week for 4–24 hour dwell times resulted in fewer catheter fractures in the polyurethane catheters compared with the silicone catheters and similar CLABSI reduction between catheter groups (14). Ashkenazi-Hoffnung et al (3) evaluated ethanol for catheter salvage in pediatric oncology patients with PICCs, venous ports, and tunneled cuffed CVCs using a dwell time of 4–48 hours.…”

“…Literature suggests that ethanol lock therapy (ELT) can be successfully used for catheter salvage as well as prophylaxis in children (8)(9)(10). Clinicians have resisted the use of ELT in polyurethane catheters due to concerns of altered catheter integrity (11)(12)(13) despite emerging evidence supporting a favorable safety profile (8)(9)(10)(14)(15)(16).…”

A survival analysis of cuffed tunneled silicon central venous catheters in children affected by short bowel syndrome: A lesson from the past

“…These devices present a larger lumen and a lower breakage rate in comparison to 2.7 Fr Broviac. 19 Even though polyurethane catheters were not fixable, this aspect might decrease the occurrence of disruptions. Their characteristics might increase the survival of the lines in the first months of life.…”