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Ethanol locks favored for central lines in children on chronic parenteral nutrition

Reuters Health • The Doctor's Channel Daily Newscast

NEW YORK (Reuters Health) – In children with intestinal failure who are dependent on parenteral nutrition through an indwelling central venous catheter, the use of ethanol locks rather than conventional heparin locks reduces the number of catheter-related bloodstream infections and catheter replacements.

That conclusion comes from a meta-analysis performed by Dr. Paul W. Wales, at The Hospital for Sick Children, Toronto, Ontario, Canada, and colleagues, and reported in the February issue of Pediatrics.

“Ethanol has 2 desired effects of a lock solution: it is antimicrobial and antifibrinolytic,” the authors point out in their paper.  While ethanol locks for preventing catheter-related bloodstream infections (CRBSI) were introduced several years ago, they are not included in current guidelines.

The team investigated the effectiveness and safety of ethanol locks in comparison to heparin locks in pediatric patients with intestinal failure by synthesizing quantitative data from four retrospective studies covering 53 patients.  All studies had a pre-post design and all used 70% ethanol solution.  Ethanol lock dwell times ranged from at least 2 hours per day to 4 hours on 3 days per week.

Ethanol locks reduced the CRBSI rate by 7.67 events per 1000 catheter-days compared with heparin locks, representing a relative risk of 0.19, the investigators report.

The number-needed-to-treat with ethanol locks instead of a heparin locks to prevent one CRBSI ranged from 108 to 150 catheter-days in the different studies.

As a secondary outcome, there were 5.07 fewer catheter replacements per 1000 catheter-days with ethanol locks versus heparin locks (relative risk 0.28), the report indicates.

While the findings encourage the use of ethanol locks in this setting, “Caution must remain, as this evidence is based on retrospective studies only and safety was not assessed systematically,” Dr. Wales and colleagues conclude.

“In the future,” they add, “randomized controlled trials and cost-effectiveness analysis need to be performed to confirm these results and assess the cost-effectiveness of this new method.”

SOURCE:
Ethanol Locks to Prevent Catheter-Related Bloodstream Infections in Parenteral Nutrition: A Meta-Analysis Pediatrics 2012;129.