Schoot, R.A., van Ommen, C.H., Stijnen, T., Tissing, W.J., Michiels, E., Abbink, F.C., . . . van de Wetering, M.D. (2015). Prevention of central venous catheter-associated bloodstream infections in paediatric oncology patients using 70% ethanol locks: A randomised controlled multi-centre trial. European Journal of Cancer, 51, 2031–2038.

To determine if 70% ethanol catheter locks can prevent central line–associated bloodstream infections (CLABSI) in pediatric patients with cancer

Patients were randomised to receive either 70% ethanol or 100 IU/ml heparin locks. Locks were used only when needed, no more than weekly if not accessed, and at least every six weeks. Catheter insertion and care were done according to international guidelines. Patients were stratified according to type of catheter, port-a-cath or broviac type, and type of disease. Two hours after the lock solution was used, the catheter was flushed with saline and the CVC was closed with heparin.

• N = 237
• MEAN AGE = 8.8 years
• AGE RANGE = 1–18 years
• MALES: 57%, FEMALES: 43%
• OTHER KEY SAMPLE CHARACTERISTICS: 94% had single-lumen catheters. The majoirty of them (51%) were placed in the right jugular vein.

• SITE: Multi-site  
• SETTING TYPE: Not specified  
• LOCATION: Netherlands

• APPLICATIONS: Pediatrics

• Single-blind randomized, controlled trial

• Central line–associated bloodstream infection (CLABSI) defined as pathogen cultured from at least one blood culture and fever, chills, or hypotension and a common skin organism from at least two culture drawn on separate locations

The total number of catheter days were 20,916 in the ethanol group and 19,915 in the heparin group. In the ethanol group, 10% of patients developed a CLABSI, compared to 19% in the heparin group (hazard ratio [HR] = 0.52, p = 0.05). CLABSI incidence per catheter days was 0.77/1000 in the ethanol group and 1.46/1000 in the heparin group (p = 0.039); however, when corrected for type of catheter, there was no significant difference between groups. Patients with internalized catheters had significantly lower risk of CLABSI (HR = 0.22, p < 0.001). Survival curve analysis at 100 days showed lower CLABSI rate in the ethanol group (p = 0.038). There was no difference between groups in the number of positive blood cultures. There was no difference in hospital days related to infection. Patients in the ethanol group reported nausea, taste alteration, and dizziness during the time of infusion or lock flushing. A larger proportion of those in the ethanol group withdrew from the study (p = 0.031).

Although authors concluded that ethanol locks reduced CLABSI rate, there was no difference when analyzed according to type of catheter, whether indwelling or not. It appears that the type of catheter may be more important for CLABSI prevention.

• Key sample group differences that could influence results
• Measurement/methods not well described
• Subject withdrawals ≥ 10%  
• No information about proportion of study groups that had indwelling catheters
• There were high catheter days in the ethanol group.
• Timing of study measures was not provided.

Findings of this study are not conclusive regarding the efficacy of two-hour ethanol CVC locks, though results are somewhat promising. Further research is needed with clear differentiation of indwelling catheter versus broviac catheters in analysis. This study used a dwell time of two hours for the ethanol lock; the optimum dwell time is unclear.