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Ethanol-lock therapy for the prevention of central venous access device infections in pediatric patients with
M Petrea Cober1, Debra S Kovacevich, Daniel H Teitelbaum
1College of Pharmacy of the University of Michigan, Ann Arbor, Michigan, USA.
Insights
Outpatient ethanol-lock therapy (ELT) significantly reduced central venous access device (CVAD) infections in pediatric patients with intestinal failure, decreasing bloodstream infection rates. This therapy is effective for long-term use in an outpatient setting.
Area of Science:
- Pediatric Gastroenterology
- Infectious Disease Prevention
- Medical Device Management
Background:
- Central venous access device (CVAD) infections are a significant complication in pediatric patients requiring long-term parenteral nutrition (PN).
- Intestinal failure patients are particularly susceptible to these infections.
- This study investigated outpatient ethanol-lock therapy (ELT) for preventing CVAD infections in this vulnerable population.
Purpose of the Study:
- To evaluate the effectiveness of outpatient ethanol-lock therapy (ELT) in preventing central venous access device (CVAD) infections.
- To assess the impact of ELT on bloodstream infection (BSI) rates in pediatric patients with intestinal failure.
- To identify potential complications associated with long-term outpatient ELT.
Main Methods:
- Retrospective analysis of 15 pediatric patients with intestinal failure receiving outpatient ELT over 2 years.
- Primary outcome: rate of bloodstream infection (BSI) per 1,000 catheter days.
- Secondary outcomes: organism types, ELT complications, and CVAD repair rates.
Main Results:
- Outpatient ELT significantly decreased the mean BSI rate from 8.0 to 1.3 per 1,000 catheter days (P < .01).
- Seventy-three percent of patients remained infection-free during the study.
- Adverse events included thrombosis (n=1), difficulty with blood withdrawal (n=3), and elevated CVAD repair rates for leakage/tear (n=20).
Conclusions:
- Outpatient ethanol-lock therapy (ELT) is effective in significantly reducing central venous access device (CVAD) infections in pediatric intestinal failure patients.
- ELT can be safely administered for extended durations in an outpatient setting.
- While effective, potential complications like CVAD repair needs should be monitored.
Background:
Central venous access device (CVAD) infections are a major complication in pediatric patients receiving long-term parenteral nutrition (PN) and are particularly prevalent in patients with intestinal failure. This study evaluated the outcomes of outpatient ethanol-lock therapy (ELT) for the prevention of CVAD infections in children with intestinal failure.
Methods:
In this retrospective analysis, the primary outcome measure was the rate of bloodstream infection (BSI) due to CVAD infections per 1,000 catheter days, and secondary measures included type of organisms cultured and complications of ELT.
Results:
Over the course of 2 years, 15 patients received outpatient ELT. Sixty-seven percent were male; patients had a mean ± standard deviation age at enrollment of 5.6 ± 6.9 years and body weight of 19.9 ± 15.4 kg. Mean duration of ELT was 263 ± 190 days. Mean BSI rate per 1,000 catheter days significantly decreased from 8.0 before ELT to 1.3 after ELT (P < .01). Seventy-three percent of patients remained infection free throughout the entire study period. Adverse events potentially related to ELT included thrombosis (n = 1), difficulty withdrawing blood from the CVAD, requiring thrombolytic administration (n = 3), and repair of the CVAD for leakage/tear (n = 20). The rate of CVAD repair for leakage/tear with ELT was compared to prior rates per 1,000 catheter days and was found to be elevated after initiation of ELT (6.4 ± 10.0 vs 3.1 ± 5.2; P = .20). No signs and symptoms of ethanol intoxication were observed.
Conclusions:
ELT for the prevention of CVAD infections in pediatric intestinal failure patients significantly decreased BSI rates and may be used for extended periods of time in an outpatient setting.
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