Clarivet Torres, Krystal Artis, Sona Sehgal, Stefanie Cahill, Parvathi Mohan

Intestinal Rehabilitation Program, Children's National Medical Center - George Washington University, Washington, DC, United States

Parenteral nutrition (PN) is the primary treatment for patients with Intestinal Failure (IF).  However, central venous catheter related infections (CVCRI) are a major cause of morbidity and mortality. 

Aim: We analyzed the outcome of the daily use of ethanol lock, started in 2009, for prevention of central venous catheter related infections (CVCRI) in patients enrolled in the Intestinal Rehabilitation Program (IRP) at our institution.

Methods: Thirteen patients in the IRP were placed on daily ethanol-lock during the time off of PN.  We reviewed the rate of CVCRI per 1000 catheter-days before and after the initiation of the lock and compared these results with a control group of 13 IF patients on PN who were not on the lock.

Results: In the study group, the catheter rate infection (CRI) before the lock was 10 per 1000 catheter-days.  In the control group, CRI was 14 per 1000 catheter-days. After the use of Ethanol lock, the CRI decreased to 4 per 1000 catheter-days.  Patients in the study group did not have any complications of line obstruction. Six of the 13 in the study group remained infection free during 2389 catheter days, whereas the control group had recurrent infections over 2776 catheter days.   Prior to the ethanol lock in both groups, the most prevalent organisms were Staphylococcus Epidermides, Klebsiella Pneumoniae and Enterococcus Faecalis.  Once the ethanol lock was started, the most prevalent bacteria were Staphylococcus Epidermides and Enterococcus Facium.  Infections from K. Pneumoniae decreased from 20% to 8% in the study group. 

Conclusion: Daily use of ethanol lock is effective and safe in preventing and reducing CVCI in IF patients on long term PN. Ethanol lock decreases the incidence of CVCRI and in particular, infections caused by gram-negative organisms.