For many years, ethanol locks have been promoted as a way to reduce central catheter-associated bloodstream infections (CCABSI).  A recent study (Ardura M I, et al. JAMA Pediatr.doi.10.1001/jamapediatrics.2014.3291 -published online Feb 2, 2015, thanks to Ben Gold for this reference) showed a dramatic reduction in CCABSI among 24 children with intestinal failure.

This study examined outcomes from January 2011-Jan 2012 with the outcomes from February 2012-December 2013.  In the latter period, ethanol lock prophylaxis was added to the CCABSI “prevention bundle” both in inpatient and outpatient settings.

Key finding: Rates of CCABSI decreased from 6.99 per 1000 catheter days to 0.42 per 1000 catheter days.

One aspect of this study that is very important is that the QI team included a specialized CVC nurse who evaluated and performed all CVC care and teaching.

Their protocol is detailed in their methods section.  Some of the details:

• Their ethanol lock utilized a 70% solution on a daily basis.
• The CVC nurse verified that the catheter was silicone prior to initial lock.
• CVC nurse used Alteplase prior to initial dwell.
• Dwell volume was determined by CVC nurse by withdrawing flush until blood return and then adding 0.1 mL for children <15 kg and adding 0.2 mL for children >15 kg (max volume 3 mL).
• Dwell times were minimum of 2 hours and maximum of 24 hours.
• At the end of the dwell time, twice the amount of the predetermined ethanol volume was withdrawn and then 5 to 10 mL of normal saline was used as a flush.

Bottomline: Ethanol locks have the potential to reduce CCABSI by 90%; this can reduce hospitalizations, prevent complications, and possibly improve survival.

Related blog posts:

• One More Way to Prevent CVL Infections | gutsandgrowth
• Ethanol locks -jump on the bandwagon | gutsandgrowth
• More on ethanol locks | gutsandgrowth
• Four advances for intestinal failure | gutsandgrowth
• Another option for line locks | gutsandgrowth
• Rehabilitation for Short Bowel Syndrome | gutsandgrowth
• IFfy outcome | gutsandgrowth

Heart-Shaped Polyp (from ACG twitter feed -recommends screening colonoscopy)