Central Venous Access Device Infections and Home Parenteral Nutrition

Cober MP, Kovacevich DS, Teitelbaum DH. Ethanol-lock therapy for the prevention of central venous access device infections in pediatric patients with intestinal failure. JPEN. 2011;35:67-73.       

Central venous access device (CVAD) infections are a problem in the home parenteral nutrition (HPN) patient. These infections include skin site infections and bloodstream infections. In fact, CVAD infection is one of the most common and most devastating complications of HPN. In this study, the Michigan group did a retrospective analysis of the use of the ethanol-lock therapy (locking the solution in the catheter between uses). The group used a 70% ethanol solution. The dwell time for the ethanol solution was 2 hours at a minimum. Patients had the ethanol drawn from the catheter and discarded prior to infusion. Catheter infections were diagnosed based on 2002 guidelines from the Centers for Disease Control and Prevention. Patients in the study were deemed at-risk (defined as having had 2 CVADs replaced because of infections or 2 previous infections from their current CVAD, or having limited remaining CVAD access). Fifteen patients, with an average age of 5.9 years, were followed over 16 months on average. Throughout the study period, 73% of patients remained infection-free. There was a statistically significant decrease in the number of BSIs (bloodstream infections) per 1,000 catheter days (8.0 BSIs before the ethanol lock technique was implemented, versus 1.3 BSIs afterward [p<.001]). None of the catheters was removed because of BSI. Two of the patients developed a tunnel infection. The incidence of CVAD repair for leakage or disruption was not significantly different than that noted before initiation of ethanol-lock therapy.

There has been some concern of catheter damage in CVADs composed of polyurethane and subjected to ethanol-lock or flush, although this has not been confirmed in clinical studies. Many interventions for CVAD infections have been examined over the years, including wound patches and biofilms (specialized devices to attach to catheters to maintain sterility), patient education, and antibiotic “lock,” among others. This study provides an alternative, and apparently successful, intervention for prevention of catheter infections in at-risk patients.