Ethanol Lock Therapy

A Pilot Infusion Study in Infants

Research output: Contribution to journalArticle

3 Citations (Scopus)

Abstract

Background: Ethanol lock therapy (ELT) has emerged as an effective method for the prevention and treatment of central line-associated bloodstream infections (CLABSIs), but the safety of ELT in infants has not been established. Objective: The objective of this study was to determine blood alcohol concentration (BAC) and evidence of hepatic injury in infants after infusing a small one-time dose of ethanol, equivalent to the volume that would be flushed through the central venous catheter (CVC) after ELT is completed. Methods: This was a prospective pilot study in infants weighing ≤6 kg with and without liver dysfunction who had a CVC. The primary end points were 5-minute and 1-hour BACs after a 0.4-mL dose of 70% ethanol was flushed through the CVC. Acceptable BACs were defined as <0.025% at 5 minutes and <0.01% at 1 hour. The secondary end point was evidence of hepatic injury, defined as a change of greater than 2 times the upper limit of normal of any component in the hepatic panel in patients with a normal baseline panel or doubling of any component in the hepatic panel in patients with an abnormal baseline panel (aspartate aminotransferase, alanine transaminase, total or direct bilirubin, gamma-glutamyl transferase, or alkaline phosphatase). Results: A total of 10 patients were included for analysis, with a mean age and weight of 3.5 ± 2.4 months and 4.5 ± 0.9 kg, respectively. All patients had acceptable BACs and no evidence of hepatic injury. In 8 patients, 5-minute BACs were undetectable; BACs of the other 2 patients were 0.011%. One-hour BACs in all patients were undetectable. Conclusions: Flushing ELT resulted in acceptable BACs and no evidence of hepatic injury in this patient cohort. Further studies are needed to investigate the long-term safety and efficacy of ethanol infusion after ELT in this patient population for the prevention and treatment of CLABSIs.

Original languageEnglish (US)
Pages (from-to)431-436
Number of pages6
JournalAnnals of Pharmacotherapy
Volume49
Issue number4
DOIs
StatePublished - Apr 16 2015

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Ethanol
Central Venous Catheters
Liver
Therapeutics
Wounds and Injuries
Safety
Transferases
Aspartate Aminotransferases
Infection
Alanine Transaminase
Bilirubin
Alkaline Phosphatase
Liver Diseases
Prospective Studies
Weights and Measures
Population

All Science Journal Classification (ASJC) codes

  • Pharmacology (medical)

Cite this

Ethanol Lock Therapy : A Pilot Infusion Study in Infants. / Chhim, Rebecca F.; Herrington, Catherine; Collier, Hailey K.; Arnold, Sandra; Pourcyrous, Massroor; Meibohm, Bernd; Christensen, Michael.

In: Annals of Pharmacotherapy, Vol. 49, No. 4, 16.04.2015, p. 431-436.

Research output: Contribution to journalArticle

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title = "Ethanol Lock Therapy: A Pilot Infusion Study in Infants",
abstract = "Background: Ethanol lock therapy (ELT) has emerged as an effective method for the prevention and treatment of central line-associated bloodstream infections (CLABSIs), but the safety of ELT in infants has not been established. Objective: The objective of this study was to determine blood alcohol concentration (BAC) and evidence of hepatic injury in infants after infusing a small one-time dose of ethanol, equivalent to the volume that would be flushed through the central venous catheter (CVC) after ELT is completed. Methods: This was a prospective pilot study in infants weighing ≤6 kg with and without liver dysfunction who had a CVC. The primary end points were 5-minute and 1-hour BACs after a 0.4-mL dose of 70{\%} ethanol was flushed through the CVC. Acceptable BACs were defined as <0.025{\%} at 5 minutes and <0.01{\%} at 1 hour. The secondary end point was evidence of hepatic injury, defined as a change of greater than 2 times the upper limit of normal of any component in the hepatic panel in patients with a normal baseline panel or doubling of any component in the hepatic panel in patients with an abnormal baseline panel (aspartate aminotransferase, alanine transaminase, total or direct bilirubin, gamma-glutamyl transferase, or alkaline phosphatase). Results: A total of 10 patients were included for analysis, with a mean age and weight of 3.5 ± 2.4 months and 4.5 ± 0.9 kg, respectively. All patients had acceptable BACs and no evidence of hepatic injury. In 8 patients, 5-minute BACs were undetectable; BACs of the other 2 patients were 0.011{\%}. One-hour BACs in all patients were undetectable. Conclusions: Flushing ELT resulted in acceptable BACs and no evidence of hepatic injury in this patient cohort. Further studies are needed to investigate the long-term safety and efficacy of ethanol infusion after ELT in this patient population for the prevention and treatment of CLABSIs.",
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AU - Chhim, Rebecca F.

AU - Herrington, Catherine

AU - Collier, Hailey K.

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AU - Meibohm, Bernd

AU - Christensen, Michael

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