Ethanol-Lock Technique for Persistent Bacteremia of Long-term Intravascular Devices in Pediatric Patients | Critical Care Medicine | JAMA Pediatrics | JAMA Network
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Article
October 2006

Ethanol-Lock Technique for Persistent Bacteremia of Long-term Intravascular Devices in Pediatric Patients

Author Affiliations

Author Affiliations: Department of Pediatrics, Emma Children's Hospital, Academic Medical Center, Amsterdam, the Netherlands (Dr Onland); and Divisions of Pediatric Surgery (Dr Shin), Hematology-Oncology (Ms Fustar and Drs Rushing and Wong), and Pharmacy (Dr Rushing), Childrens Hospital Los Angeles, Los Angeles, Calif.

Arch Pediatr Adolesc Med. 2006;160(10):1049-1053. doi:10.1001/archpedi.160.10.1049
Abstract

Objectives  To use the ethanol-lock technique (in conjunction with systemic antibiotics) to salvage central lines from removal and to prevent persistence of catheter-related infections among pediatric patients with long-term intravascular devices.

Design  Medical records of patients treated with ethanol locks were retrospectively reviewed from June 1, 2004, through June 22, 2005.

Setting  Childrens Hospital Los Angeles, Los Angeles, Calif, a tertiary care pediatric hospital.

Patients  Forty children with diverse underlying disorders were treated for 51 catheter-related infections using the Childrens Hospital Los Angeles ethanol-lock technique.

Interventions  Eligible infected central lines were instilled with a dose volume of 0.8 to 1.4 mL of 70% ethanol into the catheter lumen during 12 to 24 hours and then withdrawn. The volume of ethanol used was based on the type of intravascular device.

Main Outcome Measures  Clearance of infection and incidence of recurrence.

Results  Of the 51 ethanol-lock treatments in 40 children, no catheters were removed because of persistent infection. Eighty-eight percent (45/51) of the treated episodes cleared without recurrence (defined as a relapse within 30 days with the same pathogen). Twelve (75%) of 16 polymicrobial isolates and 33 (94%) of 35 monomicrobial isolates were successfully treated. There were no adverse reactions or adverse effects reported.

Conclusion  This retrospective study supports the use of the ethanol-lock technique in conjunction with systemic antibiotics as an effective and safe method to retain the use of a previously infected central venous catheter, decrease the need for line removal, and eradicate persistent pathogens in catheter-related infections.

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