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A comparison between sodium bicarbonate and ethanol for central line locks in pediatric patients with intestinal

Kate McNevin1, Beatrice E Rosete2, Shiho Fukasawa2

  • 1Division of Pediatric General and Thoracic Surgery, Seattle Children's Hospital, Seattle, Washington, USA.

Journal of Pediatric Gastroenterology and Nutrition
|March 9, 2026
PubMed

Insights

Sodium bicarbonate locks are a safe and effective alternative to ethanol locks for preventing central line-associated blood stream infections (CLABSI) in children with intestinal failure. This strategy also reduced line replacements and repairs.

Area of Science:

  • Pediatric Gastroenterology
  • Infectious Disease Prevention
  • Vascular Access Management

Background:

  • Children with intestinal failure (IF) require central venous catheters (CVCs) for parenteral nutrition, increasing their risk of central line-associated blood stream infections (CLABSI).
  • Ethanol lock therapy has been a standard prophylactic measure for CLABSI prevention in these patients.
  • A national ethanol shortage prompted the investigation of alternative lock solutions, specifically sodium bicarbonate.

Purpose of the Study:

  • To evaluate the efficacy of sodium bicarbonate locks compared to ethanol locks in preventing CLABSI in pediatric patients with IF.
  • To assess the impact of these lock solutions on CVC repair and replacement rates.

Main Methods:

  • A retrospective cohort study analyzed pediatric patients (0-21 years) with IF who received either ethanol or sodium bicarbonate locks between 2018 and 2023.
  • CLABSI, line repair, line replacement, and line occlusion rates were calculated per 1000 catheter days.
  • Statistical comparisons between the ethanol and sodium bicarbonate groups were performed using Mann-Whitney U or Fisher's exact tests.

Main Results:

  • The study included 55 patients: 19 in the ethanol group and 36 in the sodium bicarbonate group.
  • CLABSI rates were comparable between the two groups (2.03 vs. 1.59 per 1000 catheter days, p=0.617).
  • The sodium bicarbonate group showed significantly lower rates of line replacement (p=0.01) and a trend towards lower line repair rates (p=0.23).

Conclusions:

  • Sodium bicarbonate locks represent a safe and effective alternative to ethanol locks for CLABSI prevention in pediatric IF patients.
  • This alternative strategy is associated with equivalent CLABSI rates and reduced CVC manipulation (replacements and repairs).
  • Sodium bicarbonate offers a viable solution during ethanol shortages for maintaining CVC integrity and patient safety.
Abstract

Keywords:
central line associated bloodstream infectioncentral line maintenanceparenteral nutrition

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