Use of an ethanol lock to prevent catheter-related infections in children with short bowel syndrome

Background: Children with short bowel syndrome (SBS) requiring central venous catheters (CVCs) may experience frequent catheter-related infections (CRIs). Treatment strategies include antibiotic- and ethanol-containing locks, with CVC removal if the CRI cannot be cleared. Ethanol lock therapy has been reported for CRI treatment in children but not for CRI prevention. Methods: Medical records of children with SBS receiving cycled home parenteral nutrition via a silicone CVC and who received a daily 70% ethanol lock at some time during their therapy were reviewed retrospectively. Main Results: Ten patients had 26 CVCs for a total of 3556 catheter-days and received a daily ethanol lock for 4 to 14 hours during a total of 3018 catheter-days. Before ethanol lock therapy (n = 5), there were 6 CRIs in 538 catheter-days (rate, 11.15 per 1000 catheter-days). During ethanol lock therapy in the same 5 patients, the CRI rate decreased to 2.06 per 1000 catheter-days (4 CRIs in 1936 catheter-days). In the 5 patients with no ethanol lock-free period, the CRI rate was 1.85 per 1000 catheter-days. Overall, CRI rate with ethanol lock therapy was 1.99 per 1000 catheter-days (2 CRIs in 1081 catheter-days). Four patients developed 6 CRIs during ethanol lock therapy. Four of these CRIs were cleared with systemic anti-infective and ethanol lock therapy; 2 CVCs were removed owing to infection. No adverse reactions were reported during ethanol instillation. Conclusion: A daily 70% ethanol lock for CRI prevention was safe and effective in a series of 10 patients with SBS.