Skip to main content
Key Specialties
Cardiology Diabetology Endocrinology Gastroenterology Geriatrics and Gerontology Gynecology and Obstetrics Hematology Infectious Disease Internal Medicine Nephrology Neurology Oncology Pediatrics Respiratory Medicine Rheumatology Surgery
Congress Coverage
2024 ACC Congress 2023 ESMO Congress 2023 EASD Congress 2023 ERS Congress 2023 ESC Congress 2023 EHA Congress 2023 ASCO Annual Meeting
Clinical Collections
Advances in Alzheimer’s

At a glance: The ONWARDS insulin icodec trials

A round-up of the ONWARDS phase 3 clinical trials evaluating the novel weekly insulin icodec in people with diabetes.
ADVANCED SEARCH
Log in
Top
BMC Anesthesiology
Published in: BMC Anesthesiology 1/2018

Open Access 01-12-2018 | Research article

Ethanol locks for the prevention of catheter-related bloodstream infection: a meta-analysis of randomized control trials

Authors: Peng Zhang, Jun-Hao Lei, Xin-Jun Su, Xing-Huan Wang

Published in: BMC Anesthesiology | Issue 1/2018

Login to get access

Abstract

Background

Current evidence regarding the efficacy of ethanol locks in preventing catheter-related bloodstream infection (CRBI) is inconclusive.

Methods

Electronic databases, including PubMed, Web of Science, Embase, and the Cochrane Library (until April 2018),were systematically searched for relevant studies. Two reviewers independently screened the retrieved records and identified RCTs that met the inclusion criteria. Relevant data were extracted for pooled analyses using Review Manager 5.3 software. Subgroup analysis was performed according to the study quality, duration of the ethanol lock, disease type and CRBI definition. Eggs’ method was applied to detect publication bias. Sensitivity analysis was conducted to check the stability of the meta-analysis results.

Results

Ten RCTs involving 2760 patients were included in the analysis. The overall pooled result indicated that ethanol locks significantly reduced the incidence of CRBI (RR 0.66, 95% CI 0.51–0.86). Subgroup analysis suggested that an ethanol lock significantly decreased the incidence of CRBI in patients with hematological diseases (RR 0.50, 95% CI 0.31–0.80). An ethanol lock significantly reduced the incidence of CRBI in a2-hour ethanol lock group (RR 0.49, 95% CI 0.33–0.73). The meta-analysis showed that an ethanol lock significantly reduced the incidence of CRBI according to analysis of high-(RR 0.66, 95% CI 0.47–0.94) or low-(RR 0.66, 95% CI 0.46–0.95) quality studies. Meta-analysis of studies with a strict CRBI definition showed that an ethanol lock can significantly prevent CRBI (RR 0.61, 95% CI 0.42–0.89). The results of sensitivity analysis suggested that the pooled result was stable. Meta-analysis of adverse events showed that an ethanol lock did not increase the incidence of thrombosis (RR 1.05, 95% CI 0.51–2.18) or mortality (RR 0.99, 95% CI 0.90–1.08) but did result in increased nausea (RR 1.54, 95% CI 1.01–2.35), dizziness (RR 4.21, 95% CI 2.40–7.39),elevated blushing rates (RR 3.27, 95% CI 2.05–5.22) and altered taste rates (RR 2.61, 95% CI 1.93–3.54).

Conclusions

An ethanol lock may play a role in the prevention of CRBI, especially in immunocompromised patients with hematological diseases.
Appendix
Available only for authorised users
Literature
1.
Eggimann P. Prevention of intravascular catheter infection. Curr Opin Infect Dis. 2007;20(4):360–9.CrossRefPubMed
2.
Worth LJ, McLaws ML. Is it possible to achieve a target of zero central line associated bloodstream infections? Curr Opin Infect Dis. 2012;25(6):650–7.CrossRefPubMed
3.
Vassallo M, Dunais B, Roger PM. Antimicrobial lock therapy in central-line associated bloodstream infections: a systematic review. Infection. 2015;43(4):389–98.CrossRefPubMed
4.
Labriola L, Crott R, Jadoul M. Preventing haemodialysis catheter-related bacteraemia with an antimicrobial lock solution: a meta-analysis of prospective randomized trials. Nephrol Dial Transplant. 2008;23(5):1666–72.CrossRefPubMed
5.
Tan M, Lau J, Guglielmo BJ. Ethanol locks in the prevention and treatment of catheter-elated bloodstream infections. Ann Pharmacother. 2014;48(5):607–15.CrossRefPubMed
6.
Souweine B, Lautrette A, Gruson D, Canet E, Klouche K, Argaud L, Bohe J, Garrouste-Orgeas M, Mariat C, Vincent F, 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(9):1024–32.CrossRefPubMed
7.
Vercaigne LM, Allan DR, Armstrong SW, Zacharias JM, Miller LM. An ethanol/sodium citrate locking solution compared to heparin to prevent hemodialysis catheter-related infections: a randomized pilot study. J Vasc Access. 2016;17(1):55–62.CrossRefPubMed
8.
Schoot RA, van Ommen CH, Stijnen T, Tissing WJ, Michiels E, Abbink FC, Raphael MF, Heij HA, Lieverst JA, Spanjaard L, 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(14):2031–8.CrossRefPubMed
9.
Hannan MM, O'Sullivan KE, Higgins AM, Murphy AM, McCarthy J, Ryan E, Hurley JP. The Combined Impact of Surgical Team Education and Chlorhexidine 2% Alcohol on the Reduction of Surgical Site Infection following Cardiac Surgery. Surgical Infections. 2015;16(6):799–805.
10.
Sanders J, Pithie A, Ganly P, Surgenor L, Wilson R, Merriman E, Loudon G, Judkins R, Chambers S. 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(4):809–15.CrossRefPubMed
11.
Slobbe L, Doorduijn JK, Lugtenburg PJ, Barzouhi AE, Boersma E, van Leeuwen WB, Rijnders BJA. Prevention of catheter-related bacteremia with a daily ethanol lock in patients with tunnelled catheters: a randomized, placebo-controlled trial. PLoS One. 2010;5(5)
12.
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. 2017;37(4):1181–85.CrossRefPubMed
13.
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.CrossRefPubMedPubMedCentral
14.
Perez-Granda MJ, Barrio JM, Munoz P, Hortal J, Rincon C, Rabadan PM, Pernia MS, Bouza E. Ethanol lock therapy (E-lock) in the prevention of catheter-related bloodstream infections (CR-BSI) after major heart surgery (MHS): a randomized clinical trial. PLoS One. 2014;9(3):e91838.CrossRefPubMedPubMedCentral
15.
Sishir G, Bhupeshkumar K, Umapati H, Kalpesh G, Mohan R. To study the efficacy of intraluminal 70% ethanol vs heparin lock prior to hemodialysis in prevention of infections in non-tunneled hemodialysis catheters: a randomised study. Nephrology. 2014;19:181–2.
16.
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(1):48–51.CrossRefPubMed
17.
O'Grady NP, Alexander M, Dellinger EP, Gerberding JL, Heard SO, Maki DG, Masur H, RD MC, Mermel LA, Pearson ML, et al. Guidelines for the prevention of intravascular catheter-related infections. The hospital infection control practices advisory committee, Center for Disease Control and Prevention, U.S. Pediatrics. 2002;110(5):e51.CrossRefPubMed
18.
Mermel LA, Allon M, Bouza E, Craven DE, Flynn P, O'Grady NP, Raad II, Rijnders BJ, Sherertz RJ, Warren DK. Clinical practice guidelines for the diagnosis and management of intravascular catheter-related infection: 2009 update by the Infectious Diseases Society of America. Clin Infect Dis. 2009;49:1):1–45.PubMedPubMedCentral
19.
Hajjej Z, Nasri M, Sellami W, Gharsallah H, Labben I, Ferjani M. Incidence, risk factors and microbiology of central vascular catheter-related bloodstream infection in an intensive care unit. J Infect Chemother. 2014;20(3–4):163–8.CrossRefPubMed
20.
Buchman AL, Spapperi J, Leopold P. A new central venous catheter cap: decreased microbial growth and risk for catheter-related bloodstream infection. J Vasc Access. 2009;10(1):11–21.CrossRefPubMed
21.
Decicco M, Chiaradia V, Veronesi A, Santini G, Panarello G, Fracasso A, Testa V, Tesio F. Source and route of microbial colonization of parenteral-nutrition catheters. Lancet. 1989;2(8674):1258–61.CrossRef
22.
Sawyer M, Weeks K, Goeschel CA, Thompson DA, Berenholtz SM, Marsteller JA, Lubomski LH, Cosgrove SE, Winters BD, Murphy DJ, et al. Using evidence, rigorous measurement, and collaboration to eliminate central catheter-associated bloodstream infections. Crit Care Med. 2010;38(8):S292–8.CrossRefPubMed
23.
Crnich CJ, Maki DG. The promise of novel technology for the prevention of intravascular device-related bloodstream infection. II. Long-term devices. Clin Infect Dis. 2002;34(10):1362–8.CrossRefPubMed
24.
Metcalf SCL, Chambers ST, Pithie AD. Use of ethanol locks to prevent recurrent central line sepsis. J Infect. 2004;49(1):20–2.CrossRefPubMed
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(2):318–29.CrossRefPubMed
26.
Raad I, Hanna H, Dvorak T, Chaiban G, Hachem R. Optimal antimicrobial catheter lock solution, using different combinations of minocycline, EDTA, and 25-percent ethanol, rapidly eradicates organisms embedded in biofilm. Antimicrob Agents Chemother. 2007;51(1):78–83.CrossRefPubMed
Metadata
Title
Ethanol locks for the prevention of catheter-related bloodstream infection: a meta-analysis of randomized control trials
Authors
Peng Zhang
Jun-Hao Lei
Xin-Jun Su
Xing-Huan Wang
Publication date
01-12-2018
Publisher
BioMed Central
Published in
BMC Anesthesiology / Issue 1/2018
Electronic ISSN: 1471-2253
DOI
https://doi.org/10.1186/s12871-018-0548-y

Other articles of this Issue 1/2018

BMC Anesthesiology 1/2018 Go to the issue

Case report

Case report: life-threatening coronary artery spasm under transversus abdominis plane block in combination with general anesthesia

Research article

Hemodynamic instability during percutaneous ablation of extra-adrenal metastases of pheochromocytoma and paragangliomas: a case series

Research article

Dose selection of central or peripheral administration of sufentanil affect opioid induced cough?: a prospective, randomized, controlled trial

Research article

Pretreatment with nimodipine reduces incidence of POCD by decreasing calcineurin mediated hippocampal neuroapoptosis in aged rats

Research article

Comparison of upper airway patency in patients with mild obstructive sleep apnea during dexmedetomidine or propofol sedation: a prospective, randomized, controlled trial

Research article

Heating capabilities of small fluid warming systems