EFFICACY OF ETHANOL LOCK IN THE MANAGEMENT OF CRBSI IN TUNNELLED CENTRAL VENOUS CATHETERS - 3 YEARS' EXPERIENCE

Introduction:

Tunneled cuffed central vein catheters are now increasingly being used for hemodialysis. These catheters are the lifeline of some dialysis patients with difficult access. These catheters are prone to bacterial colonization with the formation of biofilm.

Bacteraemic episodes from these biofilms are difficult to treat, leading to complications such as endocarditis, septic emboli, metastatic abscess, etc.

Guideline-directed therapy involves antibiotic locks, systemic antibiotics and lastly, catheter removal if CRBSI persists. 70% ethanol penetrates and eradicates biofilms and has bactericidal and fungicidal properties. Bacterial resistance has not been encountered. It is readily available and cheap with a minimal side-effect profile. We analyse our experience of using ethanol lock in the treatment of CRBSI over three years.

Methods:

Hemodialysis patients with tunneled central venous catheters diagnosed with CRBSI ,a total of 70 patients based on clinical features and blood culture positivity were treated with ethanol lock therapy (70% Ethanol) of appropriate volume in each limb of double lumen catheters for four hours daily for 3, 4 or 5 days depending on the clinical severity. At the end of four hours, the catheters are relocked with heparin.

Appropriate antibiotics were given systemically for one week to 10 days depending on the severity of infection and organism.

Results:

The mean age was 50 (± 4 years)

Male: Female = 47:23.

The cumulative infection rate was 3/1000 patient days.

 
Culture was positive in 68% and culture negative in 32% of CRBSI cases.

The median days of dialysis before CRBSI onset was 85 days (64-111).

There were 60% Gram-negative, 34% Gram-positive and 6% fungal infections.

 
Multi-drug resistant bacteria were seen in 21% of cases.

 
Adequate systemic antibiotics were given in all cases.

 
70% ethanol lock was given for 5 days in 78%.

 
It was effective in 99% of cases with catheter removal in only 2 patients (both fungal infections). There were no adverse effects like catheter damage, thrombosis, and systemic toxicity to ethanol.

Conclusions:

In the Kaplan-Meier survival analysis, there was no difference in catheter survival between non-infected and those infected and treated with ethanol lock.

70% ethanol lock is highly efficacious in catheter salvage during CRBSI with 99% success rate.

No instances of adverse events to ethanol were encountered in our setting.

 
Resistance to ethanol is not an issue and was never encountered.

 
No thrombosis or catheter damage due to ethanol was experienced during the study.

No allergic reactions were encountered

I have no potential conflict of interest to disclose.

I did not use generative AI and AI-assisted technologies in the writing process.