Ethanol lock therapy increases mechanical catheter complications
Abstract:
Background: Ethanol lock therapy (ELT) decreases central line-associated bloodstream infections (CLABSIs); however, the effect on mechanical catheter complications is unclear. In recent years, ELT has become unavailable for many patients, often resulting in high-risk patients switching back to heparin locks. We investigated the impact of ELT on mechanical catheter complications during this period.
Methods: We performed a retrospective cohort study of the Boston Children’s Hospital intestinal rehabilitation program from 01/01/2018-12/31/2020. Pediatric patients with a central venous catheter (CVC) requiring parenteral support for three months were included. The primary outcome was the composite rate of mechanical catheter complications (repairs and replacements).
Results: The pediatric intestinal failure cohort consisted of 122 patients. Forty-four percent received ELT for the entirety of the study period, 29% used only heparin locks, and 27% used ELT and heparin locks at different periods. During ELT use, there was 1.65 times the risk of mechanical catheter complications (composite outcome of repairs and replacements) compared to heparin locks (adjusted incidence rate ratio [aIRR]: 1.65, 95%CI 1.18-2.31). Current ELT use was associated with 2.3 times the risk of catheter repairs (aIRR: 2.30, 95%CI: 1.36-3.89), but no significant increase in risk of catheter replacements (aIRR: 1.41, 95%CI: 0.91-2.20).
Conclusion: In the largest pediatric intestinal failure cohort evaluated to date, use of ELT, compared to heparin locks, increased the risk of mechanical catheter complications. Mechanical complications carry morbidity requiring urgent clinic or emergency department visits and additional procedures. Investigation of alternative lock solutions is warranted.
Reference:
Fligor SC, Hirsch TI, Tsikis ST, Joiner MM, Mitchell PD, Carbeau S, McClelland J, Carey A, Gura KM, Puder M. Ethanol lock therapy increases mechanical catheter complications in a pediatric intestinal failure population: a retrospective cohort study. JPEN J Parenter Enteral Nutr. 2023 Apr 18. doi: 10.1002/jpen.2509. Epub ahead of print. PMID: 37070823.