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Ethanol locks to prevent catheter-related bloodstream infections in parenteral nutrition: a meta-analysis

Carol Oliveira1, Ahmed Nasr, Mary Brindle

  • 1Group for Improvement of Intestinal Function and Treatment (GIFT), Division of General and Thoracic Surgery, The Hospital for Sick Children, Toronto, ON, Canada.

Pediatrics
|January 11, 2012
PubMed

Insights

Ethanol locks (ELs) significantly reduce catheter-related bloodstream infections (CRBSIs) and catheter replacements in pediatric intestinal failure patients compared to heparin locks (HLs). ELs are a safer, more effective alternative for chronic parenteral nutrition.

Area of Science:

  • Pediatric Gastroenterology
  • Infectious Disease Prevention
  • Critical Care Medicine

Background:

  • Pediatric intestinal failure (IF) necessitates parenteral nutrition (PN), increasing risks of catheter-related bloodstream infections (CRBSIs).
  • CRBSIs are a major cause of mortality and IF-associated liver disease in children requiring long-term PN.
  • Effective CRBSI prevention strategies are critical for improving outcomes in pediatric IF patients.

Purpose of the Study:

  • To evaluate the pooled effectiveness and safety of ethanol locks (ELs) versus heparin locks (HLs) for CRBSI prevention.
  • To compare the rates of CRBSI and catheter replacements between ELs and HLs in pediatric IF patients.
  • To assess the efficacy of EL therapy in reducing complications associated with chronic PN.

Main Methods:

  • Systematic review of Medline, Embase, and trial registries up to December 2010.
  • Inclusion of 4 retrospective studies focusing on pediatric IF patients.
  • Data extraction and risk of bias assessment using the Newcastle-Ottawa scale.

Main Results:

  • Ethanol locks reduced CRBSI rate by 81% and catheter replacements by 72% compared to heparin locks.
  • ELs decreased CRBSI events by 7.67 per 1000 catheter days and replacements by 5.07.
  • Adverse events associated with ELs were infrequent, primarily consisting of thrombotic events.

Conclusions:

  • Ethanol locks represent a more effective alternative to heparin locks for CRBSI prevention in pediatric IF.
  • EL therapy significantly lowers the incidence of CRBSIs and reduces the need for catheter replacements.
  • While effective, potential thrombotic events should be considered when using ethanol locks.
Abstract

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