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Ethanol lock prophylaxis in long-stay central venous catheters in children with severe intestinal dysfunction: a
Mário Cícero Falcão1, Gabriela Ibrahim Martins de Castro1, Juliana Valeria de Souza Framil1
1Universidade de São Paulo - USP, Instituto da Criança e do Adolescente, Faculdade de Medicina, Hospital das Clínicas, São Paulo, SP, Brasil.
Insights
Ethanol lock therapy in newborns with severe intestinal dysfunction and central venous catheters showed relative effectiveness in preventing infections. This method was well-tolerated, with no observed side effects in the studied infants.
Area of Science:
- Neonatal Medicine
- Pediatric Surgery
- Infectious Disease
Background:
- Infants with severe intestinal dysfunction often require long-term central venous catheters for parenteral nutrition.
- Catheter-related infections are a significant complication in this vulnerable population.
- Ethanol lock therapy is explored as a potential preventative measure.
Observation:
- The study reviewed six infants requiring long-term central venous catheters for parenteral nutrition between 2015-2020.
- Various catheter types were used, with a median dwell time of 182.5 days.
- Four patients experienced at least one catheter-related infection, with diverse microbial agents identified.
Findings:
- Ethanol lock therapy demonstrated relative effectiveness in preventing central venous catheter infections.
- No adverse side effects were associated with the use of ethanol lock in this cohort.
- Despite preventative measures, catheter-related infections occurred, highlighting the complexity of management.
Implications:
- Ethanol lock therapy may be a valuable, safe adjunct for infection prevention in neonatal central venous catheters.
- Further research is warranted to optimize its use and assess long-term outcomes.
- This approach could potentially reduce morbidity and healthcare costs in neonates with intestinal failure.
Abstract:
The aim of this study was to report on use of ethanol lock in long-term catheters in newborns with severe intestinal dysfunction, dependent on total and prolonged parenteral nutrition, in a Neonatal Intensive Care Center (tertiary level), between 2015 and 2020. Six infants (0.65%) out of the 914 admitted during the period met the inclusion criteria. The median age at catheter placement was 121.5 days. Two Powerpicc (PICC Power Sinergy™, São Paulo), one Groshong (Groshong™ Central Venous Catheter BD, São Paulo), and three silicone catheters were used, all tunneled, and the median dwell duration was 182.5 days. Four patients had at least one episode of infection related to the central venous catheter, and Gram-positive, Gram-negative, and fungal agents were isolated. The median length of hospital stay was 555 days and mortality was 33.3%. The ethanol lock did not cause any side effects and was relatively effective in preventing infections related to the central venous catheter.
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