Ethanol locks for the prevention of catheter-related infection in patients with central venous catheter: A systematic review and meta-analysis of randomized controlled trials


Autoři: Jun Zhang aff001;  Bo Wang aff001;  Jinxia Wang aff001;  Qin Yang aff002
Působiště autorů: School of Nursing, Gansu University of Chinese Medicine, Lanzhou, Gansu, China aff001;  Department of Special Surgery, the First Hospital of Lanzhou University, Lanzhou, Gansu, China aff002
Vyšlo v časopise: PLoS ONE 14(9)
Kategorie: Research Article
doi: 10.1371/journal.pone.0222408

Souhrn

Background

The widespread use of central venous catheters (CVCs) has exposed patients to a high risk of catheter-related infection (CRI), which is linked to substantial morbidity and mortality. Several strategies for preventing CRI, including ethanol lock prophylaxis, have been explored. This study aimed to provide a comprehensive summary of randomized controlled trials (RCTs) assessing the efficacy and safety of ethanol locks for preventing CRI in patients with CVC.

Methods

We searched six electronic databases, earlier relevant meta-analyses and the reference lists of the included studies for RCTs that assessed the effects of ethanol locks on CRI in patients with CVC versus a control group. Two authors independently assessed the methodological quality of the included studies using the Cochrane Risk of Bias tool and extracted relevant information according to a predesigned extraction form. Data were analyzed using the Cochrane Collaboration’s RevMan 5.3.

Results

Nine studies involving 2451 patients were included. Although limited in power, the results of the meta-analysis indicated a positive effect of ethanol lock prophylaxis on reducing catheter-related bloodstream infection (CRBSI) compared to heparin alone [OR = 0.53, 95% CI 0.34, 0.82, P = 0.004]. The effects on other outcomes, such as exit site infection, catheter dysfunction, catheter removal, thrombosis and mortality, were not statistically significant (P > 0.05). Moreover, although the effect of ethanol on CRBSI was in the expected direction compared to 0.9% NaCl locks, this effect was not statistically significant (P > 0.05).

Conclusions

The present data indicate that ethanol lock prophylaxis is a potential candidate for the prevention of CRBSI in patients with CVC. However, more attention should be paid to the uniform ethanol lock procedure and toxic effects after long-term ethanol lock exposure.

Klíčová slova:

Physical sciences – Chemistry – Chemical compounds – Organic compounds – Alcohols – Ethanol – Organic chemistry – Mathematics – Statistics – Biology and life sciences – Bioengineering – Biotechnology – Medical devices and equipment – Catheters – Engineering and technology – Medicine and health sciences – Pharmacology – Drugs – Heparin – Hematology – Blood coagulation – Coagulation disorders – Thrombosis – Cardiovascular medicine – Cardiovascular diseases – Vascular medicine – Nephrology – Medical dialysis – Research and analysis methods – Mathematical and statistical techniques – Statistical methods – Metaanalysis – Research design – Clinical research design – Adverse events – Research assessment – Systematic reviews


Zdroje

1. Rotstein C, Brock L, Roberts RS. The incidence of first Hickman catheter-related infection and predictors of catheter removal in cancer patients. Infect Control Hosp Epidemiol. 1995;16:451–458. 7594391

2. Coyle VM, McMullan R, Morris TC, Rooney PJ, Hedderwick S. Catheter-related bloodstream infection in adult haematology patients: catheter removal practice and outcome. J Hosp Infect. 2004;57:325–331. doi: 10.1016/j.jhin.2004.04.007 15262394

3. Crispin A, Thul P, Arnold D, Schild S, Weimann A. Central venous catheter complications during home parenteral nutrition: a prospective pilot study of 481 patients with more than 30,000 catheter days. Onkologie. 2008;31:605–609. doi: 10.1159/000162286 19145093

4. Taylor G, Gravel D, Johnston L, Embil J, Holton D, Paton S, et al. Prospective surveillance for primary bloodstream infections occurring in Canadian hemodialysis units. Infect Control Hosp Epidemiol. 2002; 23:716–720. doi: 10.1086/501999 12517012

5. Warren DK, Quadir WW, Hollenbeak CS, Elward AM, Cox MJ, Fraser VJ. Attributable cost of catheter-associated bloodstream infections among intensive care patients in a nonteaching hospital. Crit Care Med. 2006;34:2084–2089. doi: 10.1097/01.CCM.0000227648.15804.2D 16763511

6. Laupland KB, Lee H, Gregson DB, Manns BJ. Cost of intensive care unit-acquired bloodstream infections. J Hosp Infect. 2006;63:124–132. doi: 10.1016/j.jhin.2005.12.016 16621137

7. Zacharioudakis IM, Zervou FN, Arvanitis M, Ziakas PD, Mermel LA, Mylonakis E. Antimicrobial lock solutions as a method to prevent central line-associated bloodstream infections: a meta-analysis of randomized controlled trials. Clin Infect Dis. 2014;59:1741–1749. doi: 10.1093/cid/ciu671 25156111

8. Snaterse M, Rüger W, Scholte Op Reimer WJ, Lucas C. Antibiotic-based catheter lock solutions for prevention of catheter-related bloodstream infection: a systematic review of randomised controlled trials. J Hosp Infect. 2010;75:1–11. doi: 10.1016/j.jhin.2009.12.017 20227787

9. Taylor JE, Tan K, Lai NM, McDonald SJ. Antibiotic lock for the prevention of catheter-related infection in neonates. Cochrane Database Syst Rev. 2015; CD010336. doi: 10.1002/14651858.CD010336.pub2 26040840

10. Opilla MT, Kirby DF, Edmond MB. Use of ethanol lock therapy to reduce the incidence of catheter-related bloodstream infections in home parenteral nutrition patients. JPEN J Parenter Enteral Nutr. 2007;31:302–305. doi: 10.1177/0148607107031004302 17595439

11. Kayton ML, Garmey EG, Ishill NM, Cheung NK, Kushner BH, Kramer K, et al. Preliminary results of a phase I trial of prophylactic ethanol-lock administration to prevent mediport catheter-related bloodstream infections. J Pediatr Surg. 2010;45:1961–1966. doi: 10.1016/j.jpedsurg.2010.05.014 20920713

12. Pieroni KP, Nespor C, Ng M, Garcia M, Hurwitz M, Berquist WE, et al. Evaluation of ethanol lock therapy in pediatric patients on long-term parenteral nutrition. Nutr Clin Pract. 2013;28:226–231. doi: 10.1177/0884533612468009 23232749

13. Zhao T, Liu H, Han J. Ethanol lock is effective on reducing the incidence of tunneled catheter-related bloodstream infections in hemodialysis patients: a systematic review and meta-analysis. Int Urol Nephrol. 2018;50:1643–1652. doi: 10.1007/s11255-018-1855-4 29667048

14. Zhang P, Lei JH, Su XJ, Wang XH. Ethanol locks for the prevention of catheter-related bloodstream infection: a meta-analysis of randomized control trials. BMC Anesthesiol. 2018;18:93. doi: 10.1186/s12871-018-0548-y 30041610

15. Higgins JP, Altman DG, Gøtzsche PC, Jüni P, Moher D, Oxman AD, et al. The Cochrane Collaboration’s tool for assessing risk of bias in randomised trials. BMJ. 2011; 343:d5928. doi: 10.1136/bmj.d5928 22008217

16. Sanders J, Pithie A, Ganly P, Surgenor L, Wilson R, Merriman E, et al. A prospective double-blind randomized trial comparing intraluminal ethanol with heparinized saline for the prevention of catheter-associated bloodstream infection in immunosuppressed haematology patients. J Antimicrob Chemother. 2008;62:809–815. doi: 10.1093/jac/dkn284 18621987

17. Slobbe L, Doorduijn JK, Lugtenburg PJ, El Barzouhi A, Boersma E, van Leeuwen WB, et al. Prevention of catheter-related bacteremia with a daily ethanol lock in patients with tunnelled catheters: a randomized, placebo-controlled trial. PLoS One. 2010;5:e10840. doi: 10.1371/journal.pone.0010840 20520776

18. Broom JK, Krishnasamy R, Hawley CM, Playford EG, Johnson DW. A randomised controlled trial of heparin versus ethanol lock therapy for the prevention of catheter associated infection in haemodialysis patients—the HEALTHY-CATH trial. BMC Nephrol. 2012;13:146. doi: 10.1186/1471-2369-13-146 23121768

19. Yang JF, Liu Hong, Gao M, She LP, Zhang LP, Wang Y. Application of ethanol locks in maintenance hemodialysis patients with long-term catheter indwelling. Chin J Nosocomiol. 2013;23:318–319.

20. Sun XM. Ethanol versus Heparin Catheter Locks for Cuffed Central Venous Catheters in Hemodialysis Patients: A Single-center Randomized Controlled Trial. Dissertation, Southeast University. 2014. Available from: http://www.wanfangdata.com.cn/details/detail.do?_type=degree&id=Y2706576.

21. Worth LJ, Slavin MA, Heath S, Szer J, Grigg AP. Ethanol versus heparin locks for the prevention of central venous catheter-associated bloodstream infections: a randomized trial in adult haematology patients with Hickman devices. J Hosp Infect. 2014;88:48–51. doi: 10.1016/j.jhin.2014.06.007 25063013

22. Schoot RA, van Ommen CH, Stijnen T, Tissing WJ, Michiels E, Abbink FC, et al. Prevention of central venous catheter-associated bloodstream infections in paediatric oncology patients using 70% ethanol locks: A randomised controlled multi-centre trial. Eur J Cancer. 2015;51:2031–2038. doi: 10.1016/j.ejca.2015.06.126 26188849

23. Souweine B, Lautrette A, Gruson D, Canet E, Klouche K, Argaud L, et al. Ethanol lock and risk of hemodialysis catheter infection in critically ill patients. A randomized controlled trial. Am J Respir Crit Care Med. 2015;191:1024–1032. doi: 10.1164/rccm.201408-1431OC 25668557

24. Salonen BR, Bonnes SL, Vallumsetla N, Varayil JE, Mundi MS, Hurt RT. A prospective double blind randomized controlled study on the use of ethanol locks in HPN patients. Clin Nutr. 2018;37:1181–1185. doi: 10.1016/j.clnu.2017.05.009 28576557

25. Oliveira C, Nasr A, Brindle M, Wales PW. Ethanol locks to prevent catheter-related bloodstream infections in parenteral nutrition: a meta-analysis. Pediatrics. 2012;129:318–329. doi: 10.1542/peds.2011-1602 22232307

26. Tan M, Lau J, Guglielmo BJ. Ethanol locks in the prevention and treatment of catheter-related bloodstream infections. Ann Pharmacother. 2014;48:607–615. doi: 10.1177/1060028014524049 24554477

27. Zhang J, li RK, Chen KH, Ge L, Tian JH. Antimicrobial lock solutions for the prevention of catheter-related infection in patients undergoing haemodialysis: study protocol for network meta-analysis of randomised controlled trials. BMJ Open. 2016;6:e010264. doi: 10.1136/bmjopen-2015-010264 26733573

28. Takla TA, Zelenitsky SA, Vercaigne LM. Effectiveness of a 30% ethanol/4% trisodium citrate locking solution in preventing biofilm formation by organisms causing haemodialysis catheter-related infections. J Antimicrob Chemother. 2008;62:1024–1026. doi: 10.1093/jac/dkn291 18641034

29. Balestrino D, Souweine B, Charbonnel N, Lautrette A, Aumeran C, Traoré O, et al. Eradication of microorganisms embedded in biofilm by an ethanol-based catheter lock solution. Nephrol Dial Transplant. 2009;24:3204–3209. doi: 10.1093/ndt/gfp187 19383833

30. Oliver MJ, Callery SM, Thorpe KE, Schwab SJ, Churchill DN. Risk of bacteremia from temporary hemodialysis catheters by site of insertion and duration of use: a prospective study. Kidney Int. 2000;58:2543–2545. doi: 10.1046/j.1523-1755.2000.00439.x 11115089

31. Pennington CR, Pithie AD. Ethanol lock in the management of catheter occlusion. JPEN J Parenter Enteral Nutr. 1987;11:507–508. doi: 10.1177/0148607187011005507 3116300

32. Johnston DA, Walker K, Richards J, Pennington CR. Ethanol flush for the prevention of catheter occlusion. Clin Nutr. 1992;11:97–100. 16839980

33. Crnich CJ, Halfmann JA, Crone WC, Maki DG. The effects of prolonged ethanol exposure on the mechanical properties of polyurethane and silicone catheters used for intravascular access. Infect Control Hosp Epidemiol. 2005;26:708–714. doi: 10.1086/502607 16156328

34. Bell AL, Jayaraman R, Vercaigne LM. Effect of ethanol/trisodium citrate lock on the mechanical properties of carbothane hemodialysis catheters. Clin Nephrol. 2006;65:342–348. doi: 10.5414/cnp65342 16724655

35. Mermel LA, Alang N. Adverse effects associated with ethanol catheter lock solutions: a systematic review. J Antimicrob Chemother. 2014;69:2611–2619. doi: 10.1093/jac/dku182 24891431


Článek vyšel v časopise

PLOS One


2019 Číslo 9

Nejčtenější v tomto čísle

Tomuto tématu se dále věnují…