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Preliminary results of a phase I trial of prophylactic ethanol-lock administration to prevent mediport catheter-related bloodstream infections

2010; Elsevier BV; Volume: 45; Issue: 10 Linguagem: Inglês

10.1016/j.jpedsurg.2010.05.014

1531-5037

Mark L. Kayton, Edward G. Garmey, Nicole Ishill, Nai‐Kong V. Cheung, Brian H. Kushner, Kim Kramer, Shakeel Modak, Carol Rossetto, Courtney Hennelly, Melissa Parra Doyle, Shoshana M. Rosenberg, Olga Santoro, Michael P. LaQuaglia,

Cardiac Arrest and Resuscitation

BackgroundCatheter-related bloodstream infections remain costly with no simple prevention. We report preliminary results of a phase I trial of ethanol-lock administration to prevent mediport catheter-related bloodstream infections in children.MethodsTwelve patients receiving intravenous antibody treatments for neuroblastoma were enrolled. On 4 days of each 5-day antibody cycle, 70% ethanol was administered instead of heparin to dwell in each patient's mediport overnight. We used clinical monitoring/questionnaires to assess symptoms and measured blood ethanol levels and liver functions. Patients were tracked for positive blood cultures. Time to infection for ethanol-lock–treated patients was compared with historical controls.ResultsWe administered 123 ethanol-locks. No adverse symptoms attributable to ethanol occurred; one patient's urticaria worsened. Blood ethanol levels averaged 11 mg/dL. The study was voluntarily suspended after 3 patients' catheters became occluded, 1 of which fractured. A positive blood culture occurred in 1 (8%) of 12 patients, but suspension of the study precluded statistical power to detect impact on time to infection.ConclusionsAlthough children with mediport catheters exhibited nontoxic blood ethanol levels and a low rate of bloodstream infections following prophylactic ethanol-lock use, there was a high incidence of catheter occlusion. Adjustments are necessary before adopting ethanol-locks for routine prophylaxis against catheter infections in children.