Use of ethanol locks to prevent recurrent central line sepsis

Metcalf, Sarah; Chambers, Stephen T.; Pithie, Alan

doi:10.1016/j.jinf.2003.08.010

Cited by 97 publications

(92 citation statements)

References 11 publications

Supporting

Mentioning

Contrasting

Unclassified

Order By: Relevance

“…Two hours of exposure to 70% ethanol is required to kill established biofilms of grampositive bacteria, gram-negative bacteria, and Candida species in vitro. 22 The number of infections in our study period per 1000 catheter-days (6.3 infections) is higher than that reported in the study by Dannenberg et al 16 This is probably because 5 of the 42 catheters were inserted before the beginning of the study period, and these catheterdays without CRIs were excluded in the analyses. Other reasons may include our inclusion of younger and sicker children, different groups of underlying illnesses, and various types of catheters at high risk for CRIs.…”

Section: Commentcontrasting

confidence: 60%

Ethanol-Lock Technique for Persistent Bacteremia of Long-term Intravascular Devices in Pediatric Patients

Onland¹,

Shin²,

Fustar³

et al. 2006

Arch Pediatr Adolesc Med

115

117

View full text Add to dashboard Cite

Objectives: To use the ethanol-lock technique (in conjunction with systemic antibiotics) to salvage central lines from removal and to prevent persistence of catheterrelated infections among pediatric patients with longterm intravascular devices. Patients: Forty children with diverse underlying disorders were treated for 51 catheter-related infections using the Childrens Hospital Los Angeles ethanol-lock technique.Interventions: Eligible infected central lines were instilled with a dose volume of 0.8 to 1.4 mL of 70% ethanol into the catheter lumen during 12 to 24 hours and then withdrawn. The volume of ethanol used was based on the type of intravascular device. Main Outcome Measures:Clearance of infection and incidence of recurrence.Results: Of the 51 ethanol-lock treatments in 40 children, no catheters were removed because of persistent infection. Eighty-eight percent (45/51) of the treated episodes cleared without recurrence (defined as a relapse within 30 days with the same pathogen). Twelve (75%) of 16 polymicrobial isolates and 33 (94%) of 35 monomicrobial isolates were successfully treated. There were no adverse reactions or adverse effects reported. Conclusion:This retrospective study supports the use of the ethanol-lock technique in conjunction with systemic antibiotics as an effective and safe method to retain the use of a previously infected central venous catheter, decrease the need for line removal, and eradicate persistent pathogens in catheter-related infections.

show abstract

Section: Commentcontrasting

confidence: 60%

Ethanol-Lock Technique for Persistent Bacteremia of Long-term Intravascular Devices in Pediatric Patients

Onland¹,

Shin²,

Fustar³

et al. 2006

Arch Pediatr Adolesc Med

115

117

View full text Add to dashboard Cite

show abstract

“…Minocycline-edetate calcium disodium (MEDTA) (7,11,25,27,30), taurolidine-polyvinylpyrolidine (T/PVP) (2,6,33,38,45), and ethanol (E) (14,21,23) are promising lock solutions. We examined the relative efficacies of vancomycin (V), ciprofloxacin (C), minocycline (M), minocycline-rifampin (M/R), ciprofloxacin-rifampin (C/R), vancomycin-rifampin (V/R), E, EDTA, MEDTA, and T/PVP at killing Staphylococcus aureus, Staphylococcus epidermidis, Pseudomonas aeruginosa, and Candida albicans growing in biofilms.…”

mentioning

confidence: 99%

Comparative In Vitro Efficacies of Various Catheter Lock Solutions

Sherertz

Boger

Collins

et al. 2006

Antimicrob Agents Chemother

109

View full text Add to dashboard Cite

MEDTA (minocycline-edetate calcium disodium), taurolidine (2%)-polyvinylpyrolidine (5%) (T/PVP), and ethanol as potential catheter lock solutions have a unique mechanism of action, broad-spectrum activity, and anticoagulant properties. Traditional lock solutions minocycline (M), rifampin (R), ciprofloxacin (C), and vancomycin, except pharmacologic concentrations of C and R and of M and R, were less effective than MEDTA and T/PVP. Minocycline-edetate calcium disodium (MEDTA) (7,11,25,27,30), taurolidine-polyvinylpyrolidine (T/PVP) (2,6,33,38,45), and ethanol (E) (14, 21, 23) are promising lock solutions. We examined the relative efficacies of vancomycin (V), ciprofloxacin (C), minocycline (M), minocycline-rifampin (M/R), ciprofloxacin-rifampin (C/R), vancomycin-rifampin (V/R), E, EDTA, MEDTA, and T/PVP at killing Staphylococcus aureus, Staphylococcus epidermidis, Pseudomonas aeruginosa, and Candida albicans growing in biofilms.Silicone Hickman catheter segments (1 cm) were incubated overnight at 37°C in tryptic soy broth (two to four replicates per condition) for growth of each organism. Segments were removed, rinsed thrice in phosphate-buffered saline (PBS), and incubated in various lock solutions for 0, 2, 4, or 24 h at 37°C. Segments were removed, washed 10 times in PBS, placed in tryptic soy broth, sonicated for 3 min, vortexed for 10 s, serially diluted, and plated on blood agar. CFU were counted after 24 h of incubation at 37°C and converted to log 10 values. Each experiment was duplicated. Values were averaged, and the means were graphed. Results at 24 h were compared using analysis of variance and Student's t test (Minitab, Penn State University, PA).The most common causative organisms of vascular catheter infections are S. epidermidis, S. aureus, and yeasts, including C. albicans (18). P. aeruginosa causes severe, often difficult-toeradicate bloodstream infections. We used the P1 S. aureus strain (13, 39), the slime-producing RP62A S. epidermidis strain (12), and P. aeruginosa and C. albicans catheter-related bloodstream infection isolates. MICs (in micrograms per milliliters) were determined for M, R, C, and V: for S. aureus, MICs were Յ0.5, Յ0.12, Յ0.12, and Յ0.5, respectively; for S. epidermidis, MICs were Յ0.5, Յ0.12, 0.25, and 1.0; for P. aeruginosa, MICs were 4.0, Ͼ4.0, Յ0.12, and Ͼ16.0; and for C. albicans, MICs were 2.0, Ͼ8.0, Ͼ2.0, and Ͼ16.0. The following lock solutions were investigated: the therapeutic concentration (attainable serum concentration) (31,40,46,48) for M was 2

show abstract

“…Systemic interventions, such as management of indolent infections, drainage of abscesses, control of the microflora, and use of antimicrobial agents, such as antibiotic locks and ethanol locks, are considered essential. 50,51 The patient's underlying immune status naturally contributes to the efficacy of treatment, but can also be adversely impacted by an excess provision of lipids, which impair white blood-cell function.…”

Section: Complications Associated With Parenteral Nutritionmentioning

confidence: 99%

Parenteral nutrition in intestinal failure

Kurkchubasche¹,

Herron²,

Winkler³

2015

NDS

View full text Add to dashboard Cite

Abstract:Intestinal failure is a consequence of extensive surgical resection resulting in anatomic loss and/or functional impairment in motility or absorptive capacity. The condition is clinically characterized by the inability to maintain fluid, energy, protein, electrolyte, or micronutrient balance when on a conventionally accepted, normal diet. Parenteral nutrition (PN) is the cornerstone of management until intestinal adaptation returns the patient to a PN-independent state. Intestinal length, residual anatomic segments and motility determine the need for and duration of parenteral support. The goals of therapy are to provide sufficient nutrients to enable normal growth and development in children, and support a healthy functional status in adults. This review addresses indications for PN, the formulation of the PN solution, patient monitoring, and considerations for prevention of PN-associated complications. With the ultimate goal of achieving enteral autonomy, the important role of diet, pharmacologic interventions, and surgery is discussed.

show abstract

Use of ethanol locks to prevent recurrent central line sepsis

Cited by 97 publications

References 11 publications

Ethanol-Lock Technique for Persistent Bacteremia of Long-term Intravascular Devices in Pediatric Patients

Ethanol-Lock Technique for Persistent Bacteremia of Long-term Intravascular Devices in Pediatric Patients

Comparative In Vitro Efficacies of Various Catheter Lock Solutions

Parenteral nutrition in intestinal failure

Contact Info

Product

Resources

About