Wales WP, Kosar C, Carricato M, de Silva N, Lang K, Avitzur Y. Ethanol lock therapy to reduce the incidence of catheter-related bloodstream infections in home parenteral nutrition patients with intestinal failure: preliminary experience. J Pediatr Surg. 2011;46:951–956.
Catheter-related bloodstream infections (CRBSIs) are a major cause of morbidity and mortality in the home parenteral nutrition (HPN) patient population. In the pediatric literature, case reports have noted the success of ethanol “catheter lock” in the treatment and prevention of CRBSIs.
In this article, Wales et al reported on the technique of locking 1–3 cc of 70% ethanol into central venous catheters (CVCs) used for HPN in a pediatric population. Ethanol was “locked” within the CVC for 4 hours between daily PN infusion cycles and then flushed through into the bloodstream. Ten patients began treatment with ethanol lock. Previously, this group had experienced 91 CRBSIs, with a mean of 10+/- 6.2 infections per 1,000 catheter days (CDs). They also experienced 5.6 catheter replacements per 1,000 CDs. Post-institution of the ethanol lock technique, the CRBSI infection rate in this same group was 0.9+/- 1.8 per 1,000 CDs (p=.005 when compared to prior experience). CVC replacements were now 0.3/1,000 CDs (p=.038 when compared to prior experience).
Ethanol is an inexpensive antiseptic that is usually widely available. It works through protein denaturation of bacterial and fungal elements. Bench-top studies have shown that polyurethane and silicone CVCs can be immersed in 70% ethanol for 24 hours/day for 24 hours to 10 weeks without damage to the catheters.
This is one of a number of small, prospective observational studies noting a reduction in CRBSIs using the ethanol lock technique as compared to historical controls in the same patient population. To date, the reported complications to patients or CVCs while using this technique have been minimal. An appropriately powered prospective, randomized trial is necessary to confirm ethanol lock as an effective therapy for CVC infections. However, the number of reported small, positive trials to date in the literature would warrant its current use in patients at high risk for catheter infections.
Jun 29, 2012
Causes of Feelings of Burden for Caregivers of Pediatric HEN Patients
Calderón C, Gómez-López L, Martínez-Costa C, Borrcas Z, Moreno-Villero JM, Pedrón-Giner C. Feeling of burden, psychological distress and anxiety among primary caregivers of children with home enteral nutrition. J Pediatr Psychol. 2011 Mar;36(2):188–195.
For caregivers, the psychological impact of home care activities, such as home enteral nutrition (HEN), is determined by a number of factors. These include external forces (social support, the caregiver’s socioeconomic status, the doctor-patient relationship, knowledge of the disease, and home equipment needs); patient-dependent factors (illness severity, short-term prognosis, patient-caregiver relationship and patient psychological status); and caregiver-dependent factors (lifestyle, anxiety, ability to perform tasks, employment demands, and levels of grief and fear).
Calderón and colleagues examined the relationship between severe psychological factors and the burden experienced by caregivers of HEN pediatric patients. Fifty-six mothers who served as primary caregivers for their children on long-term HEN were evaluated for overall “caregiver burden” using standardized tools.
Researchers found that maternal age and family socioeconomic status were not significantly related to caregiver burden. Also, no specific patient diagnosis was related to caregiver burden. However, caregiver anxiety and psychological stress significantly increased the degree of caregiver burden. Although not demonstrated here, other studies have shown that the number and complexity of a patient’s disease did impact caregiver burden.
This study underscores the impact of the caregiver’s mental health and ability to cope with stress on their feelings of “burden.” These increased feelings of burden could result in marital discourse, resentment, reduced quality of life, and poorer overall care delivered by the caregiver. Health providers, including home care and home equipment providers, need to be fully aware of these issues and the potential impact they may have on the patient. Efforts should be made to assess caregiver burden during the course of a patient’s treatment in the home environment.
For caregivers, the psychological impact of home care activities, such as home enteral nutrition (HEN), is determined by a number of factors. These include external forces (social support, the caregiver’s socioeconomic status, the doctor-patient relationship, knowledge of the disease, and home equipment needs); patient-dependent factors (illness severity, short-term prognosis, patient-caregiver relationship and patient psychological status); and caregiver-dependent factors (lifestyle, anxiety, ability to perform tasks, employment demands, and levels of grief and fear).
Calderón and colleagues examined the relationship between severe psychological factors and the burden experienced by caregivers of HEN pediatric patients. Fifty-six mothers who served as primary caregivers for their children on long-term HEN were evaluated for overall “caregiver burden” using standardized tools.
Researchers found that maternal age and family socioeconomic status were not significantly related to caregiver burden. Also, no specific patient diagnosis was related to caregiver burden. However, caregiver anxiety and psychological stress significantly increased the degree of caregiver burden. Although not demonstrated here, other studies have shown that the number and complexity of a patient’s disease did impact caregiver burden.
This study underscores the impact of the caregiver’s mental health and ability to cope with stress on their feelings of “burden.” These increased feelings of burden could result in marital discourse, resentment, reduced quality of life, and poorer overall care delivered by the caregiver. Health providers, including home care and home equipment providers, need to be fully aware of these issues and the potential impact they may have on the patient. Efforts should be made to assess caregiver burden during the course of a patient’s treatment in the home environment.
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