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

Department of Surgery, Memorial Sloan-Kettering Cancer Center, New York, NY 10065, USA.
Journal of Pediatric Surgery (Impact Factor: 1.39). 10/2010; 45(10):1961-6. DOI: 10.1016/j.jpedsurg.2010.05.014
Source: PubMed


Catheter-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.
Twelve 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.
We 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.
Although 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.

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    • "An uncontrolled trial of prophylactic ethanol locks in paediatric patients undergoing monoclonal antibody treatment for neuroblastoma was ceased early when 3 of 12 catheters became occluded [14]. The low numbers in this trial and the lack of a control group limit the conclusions that can be drawn, but indicate that ethanol lock treatments should be prospectively studied and appropriately controlled to evaluate this complication in paediatric populations. "
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