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Ethanol Lock Technique: Review of the Literature

Published online by Cambridge University Press:  02 January 2015

Melissa Maiefski ,
Mark E. Rupp  and
Elizabeth D. Hermsen
Melissa Maiefski
Affiliation:
Department of Pharmaceutical and Nutrition Care, Nebraska Medical Center, Omaha, Nebraska
Mark E. Rupp
Affiliation:
Section of Infectious Diseases, Department of Internal Medicine, University of Nebraska Medical Center, Omaha, Nebraska
Elizabeth D. Hermsen*
Affiliation:
Department of Pharmaceutical and Nutrition Care, Nebraska Medical Center, Omaha, Nebraska Department of Pharmacy Practice, College of Pharmacy, Omaha, Nebraska Section of Infectious Diseases, Department of Internal Medicine, University of Nebraska Medical Center, Omaha, Nebraska
*
Department of Pharmaceutical and Nutrition Care, Nebraska Medical Center, 984031 Nebraska Medical Center, Omaha, NE 68198-4031 ([email protected])
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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.

Type
Review Article
Information
Infection Control & Hospital Epidemiology , Volume 30 , Issue 11 , November 2009 , pp. 1096 - 1108
Copyright
Copyright © The Society for Healthcare Epidemiology of America 2009

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References

1.Mermel, LA, Farr, BM, Sherertz, RJ, et al.Guidelines for the management of intravascular catheter-related infections. Clin Infect Dis 2001;32:1249–1272.Google Scholar
2.Darouiche, RO. Device-associated infections: a macroproblem that starts with microadherence. Clin Infect Dis 2001;33:1567–1572.Google Scholar
3.Mermel, LA. Prevention of intravascular catheter-related infections [published correction appears in Ann Intern Med 2000; 133:395]. Ann Intern Med 2000;132:391–402.CrossRefGoogle ScholarPubMed
4.Dimick, JB, Pelz, RK, Consunji, R, Swoboda, SM, Hendrix, CW, Lipsett, PA. Increased resource use associated with catheter-related bloodstream infection in the surgical intensive care unit. Arch Surg 2001;136:229–234.CrossRefGoogle ScholarPubMed
5.Warren, DK, Quadir, WW, Hollenbeak, CS, Elward, AM, Cox, MJ, Fraser, VJ. Attributable cost of catheter-associated bloodstream infections among intensive care patients in a nonteaching hospital. Crit Care Med 2006;34:2084–2089.CrossRefGoogle Scholar
6.Blot, SI, Depuydt, P, Annemans, L, et al.Clinical and economic outcomes in critically ill patients with nosocomial catheter-related bloodstream infections. Clin Infect Dis 2005;41:1591–1598.CrossRefGoogle ScholarPubMed
7.Renaud, B, Brun-Buisson, C. Outcomes of primary and catheter-related bacteremia: a cohort and case-control study in critically ill patients. Am J Respir Crit Care Med 2001;163:1584–1590.Google Scholar
8.Maki, DG, Kluger, DM, Crnich, CJ. The risk of bloodstream infection in adults with different intravascular devices: a systematic review of 200 published prospective studies. Mayo Clin Proc 2006;81:1159–1171.Google Scholar
9.Pittet, D, Tarara, D, Wenzel, RP. Nosocomial bloodstream infection in critically ill patients: excess length of stay, extra costs, and attributable mortality. JAMA 1994;271:1598–1601.Google Scholar
10.Beathard, GA. Management of bacteremia associated with tunneled-cuffed hemodialysis catheters. J Am Soc Nephrol 1999;10:1045–1049.Google Scholar
11.Tanriover, B, Carlton, D, Saddekni, S, et al.Bacteremia associated with tunneled dialysis catheters: comparison of two treatment strategies. Kidney Int 2000;57:2151–2155.CrossRefGoogle ScholarPubMed
12.Percival, SL, Kite, P. Intravascular catheters and biofilm control. J Vasc Access 2007;8:69–80.CrossRefGoogle ScholarPubMed
13.Sherertz, RJ, Boger, MS, Collins, CA, Mason, L, Raad, II. Comparative in vitro efficacies of various catheter lock solutions. Antimicrob Agents Chemother 2006;50:1865–1868.CrossRefGoogle ScholarPubMed
14.Bestul, MB, Vandenbussche, HL. Antibiotic lock technique: review of the literature. Pharmacotherapy 2005;25:211–227.CrossRefGoogle ScholarPubMed
15.Edgeworth, JD, Treacher, DF, Eykyn, SJ. A 25-year study of nosocomial bacteremia in an adult intensive care unit. Crit Care Med 1999;27:1421–1428.CrossRefGoogle Scholar
16.Linares, J, Sitges-Serra, A, Garau, J, Perez, JL, Martin, R. Pathogenesis of catheter sepsis: a prospective study with quantitative and semiquantitative cultures of catheter hub and segments. J Clin Microbiol 1985;21:357–360.Google Scholar
17.O'Grady, NP, Alexander, M, Dellinger, EP, et al.Guidelines for the prevention of intravascular catheter-related infections. Am J Infect Control 2002;30:476–489.Google Scholar
18.Maki, DG, Stolz, SM, Wheeler, S, Mermel, LA. Prevention of central venous catheter-related bloodstream infection by use of an antiseptic-impregnated catheter: a randomized, controlled trial. Ann Intern Med 1997;127:257–266.CrossRefGoogle ScholarPubMed
19.Raad, II, Hanna, HA. Intravascular catheter-related infections: new horizons and recent advances. Arch Intern Med 2002;162:871–878.Google Scholar
20.McConnell, SA, Gubbins, PO, Anaissie, EJ. Do antimicrobial-impregnated central venous catheters prevent catheter-related bloodstream infection? Clin Infect Dis 2003;37:65–72.CrossRefGoogle ScholarPubMed
21.Marciante, KD, Veenstra, DL, Lipsky, BA, Saint, S. Which antimicrobial impregnated central venous catheter should we use? modeling the costs and outcomes of antimicrobial catheter use. Am J Infect Control 2003;31:1–8.CrossRefGoogle ScholarPubMed
22.Richards, MJ, Edwards, JR, Culver, DH, Gaynes, RP. Nosocomial infections in coronary care units in the United States. National Nosocomial Infections Surveillance system. Am J Cardiol 1998;82:789–793.Google Scholar
23.Marr, KA, Sexton, DJ, Conlon, PJ, Corey, GR, Schwab, SJ, Kirkland, KB. Catheter-related bacteremia and outcome of attempted catheter salvage in patients undergoing hemodialysis. Ann Intern Med 1997;127:275–280.CrossRefGoogle ScholarPubMed
24.Sanders, J, Pithie, A, Ganly, P, et al.A prospective double-blind randomized trial comparing intraluminal ethanol with heparinized saline for the prevention of catheter-associated bloodstream infection in immunosuppressed haematology patients. J Antimicrob Chemother 2008;62:809–815.CrossRefGoogle ScholarPubMed
25.Dogra, GK, Herson, H, Hutchison, B, et al.Prevention of tunneled hemodialysis catheter-related infections using catheter-restricted filling with gentamicin and citrate: a randomized controlled study. J Am Soc Nephrol 2002;13:2133–2139.Google Scholar
26.Dannenberg, C, Bierbach, U, Rothe, A, Beer, J, Korholz, D. Ethanol-lock technique in the treatment of bloodstream infections in pediatric oncology patients with Broviac catheter. J Pediatr Hematol Oncol 2003;25:616–621.CrossRefGoogle ScholarPubMed
27.Ball, PA, Brokenshire, E, Parry, B, et al.Ethanol locking as a possible treatment for microbial contamination of long-term central venous catheters. Nutrition 2003;19:570.Google Scholar
28.Broom, J, Woods, M, Allworth, A, et al.Ethanol lock therapy to treat tunnelled central venous catheter-associated blood stream infections: results from a prospective trial. Scand J Infect Dis 2008;40:399–406.Google Scholar
29.Mouw, E, Chessman, K, Lesher, A, Tagge, E. Use of an ethanol lock to prevent catheter-related infections in children with short bowel syndrome. J Pediatr Surg 2008;43:1025–1029.CrossRefGoogle ScholarPubMed
30.Onland, W, Shin, CE, Fustar, S, Rushing, T, Wong, WY. Ethanol-lock technique for persistent bacteremia of long-term intravascular devices in pediatric patients. Arch Pediatr Adolesc Med 2006;160:1049–1053.Google Scholar
31.Opilla, MT, Kirby, DF, Edmond, MB. Use of ethanol lock therapy to reduce the incidence of catheter-related bloodstream infections in home parenteral nutrition patients. JPEN J Parenter Enteral Nutr 2007;31:302–305.CrossRefGoogle ScholarPubMed
32.Crnich, CJ, Halfmann, JA, Crone, WC, Maki, DG. The effects of prolonged ethanol exposure on the mechanical properties of polyurethane and silicone catheters used for intravascular access. Infect Control Hosp Epidemiol 2005;26:708–714.Google Scholar
33.Bell, AL, Jayaraman, R, Vercaigne, LM. Effect of ethanol/trisodium citrate lock on the mechanical properties of carbothane hemodialysis catheters. Clin Nephrol 2006;65:342–348.Google Scholar
34.Pennington, CR, Pithie, AD. Ethanol lock in the management of catheter occlusion. JPEN J Parenter Enteral Nutr 1987;11:507–508.CrossRefGoogle ScholarPubMed
35.Raad, II, Luna, M, Khalil, SA, Costerton, JW, Lam, C, Bodey, GP. The relationship between the thrombotic and infectious complications of central venous catheters. JAMA 1994;271:1014–1016.Google Scholar
36.Timsit, JF, Farkas, JC, Boyer, JM, et al.Central vein catheter-related thrombosis in intensive care patients: incidence, risks factors, and relationship with catheter-related sepsis. Chest 1998;114:207–213.Google Scholar
37.Werlin, SL, Lausten, T, Jessen, S, et al.Treatment of central venous catheter occlusions with ethanol and hydrochloric acid. JPEN J Parenter Enteral Nutr 1995;19:416–418.CrossRefGoogle ScholarPubMed
38.Takla, TA, Zelenitsky, SA, Vercaigne, LM. Effectiveness of a 30% ethanol/4% trisodium citrate locking solution in preventing biofilm formation by organisms causing haemodialysis catheter-related infections. J Antimicrob Chemother 2008;62:1024–1026.CrossRefGoogle ScholarPubMed
39.Raad, I, Hanna, H, Dvorak, T, Chaiban, G, Hachem, R. Optimal antimicrobial catheter lock solution, using different combinations of minocycline, EDTA, and 25-percent ethanol, rapidly eradicates organisms embedded in biofilm. Antimicrob Agents Chemother 2007;51:78–83.CrossRefGoogle ScholarPubMed
40.Mukherjee, PK, Mohamed, S, Chandra, J, et al.Alcohol dehydrogenase restricts the ability of the pathogen Candida albicans to form a biofilm on catheter surfaces through an ethanol-based mechanism. Infect Immun 2006;74:3804–3816.CrossRefGoogle Scholar
41.Chambers, ST, Pithie, A, Gallagher, K, Liu, T, Charles, CJ, Seaward, L. Treatment of Staphylococcus epidermidis central vascular catheter infection with 70% ethanol locks: efficacy in a sheep model. J Antimicrob Chemother 2007;59:779–782.Google Scholar
42.Guenu, S, Heng, AE, Charbonne, F, et al.Mass spectrometry and scanning electron microscopy study of silicone tunneled dialysis catheter integrity after an exposure of 15 days to 60% ethanol solution. Rapid Commun Mass Spectrom 2007;21:229–236.Google Scholar
43.International Organization for Standardization. ISO 10555-1: Sterile, single-use intravascular catheters, part 1, annex B. Geneva, Switzerland: International Organization for Standardization; 1995.Google Scholar
44.Laird, J, Soutar, R, Butcher, I. Complications of the ethanol-lock technique in the treatment of central venous catheter sepsis [letter]. J Infect 2005;51:338.Google Scholar
45. Nebraska Medical Center. Ethanol lock technique for prevention and treatment of central line–associated bloodstream infections (CLA-BSIs). Omaha, Nebraska: Nebraska Medical Center. Available at: http://www.nebraskamed.com/App_Files/pdf/careers/educatiori/asp/TNMC_EtOHLock_final.pdf.Google Scholar
46.Yokoyama, H, Aoyama, T, Matsuyama, T, et al.The cause of polyurethane catheter cracking during constant infusion of etoposide (VP-16) injection [in Japanese]. Yakugaku Zasshi 1998;118:581–588.CrossRefGoogle ScholarPubMed