Preliminary results of a phase I trial of prophylactic ethanol-lock administration to prevent mediport catheter-related bloodstream infections
Abstract Background Catheter-related bloodstream infections remain costly with no simple prevention. We report preliminary results of a phase I trial of ethanol-lock administration to prevent mediport catheter-related bloodstream infections in children. Methods Twelve patients receiving intravenous...
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| Veröffentlicht in: | Journal of pediatric surgery 2010-10, Vol.45 (10), p.1961-1966 |
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| creator | Kayton, Mark L., MD Garmey, Edward G., MD Ishill, Nicole M., MS Cheung, Nai-Kong V., MD, PhD Kushner, Brian H., MD Kramer, Kim, MD Modak, Shakeel, MD Rossetto, Carol, RN, MSN Hennelly, Courtney, RN, MS Parra Doyle, Melissa, RN, MSN Rosenberg, Shoshana, MPH Santoro, Olga, BS La Quaglia, Michael P., MD |
| description | Abstract Background Catheter-related bloodstream infections remain costly with no simple prevention. We report preliminary results of a phase I trial of ethanol-lock administration to prevent mediport catheter-related bloodstream infections in children. Methods Twelve patients receiving intravenous antibody treatments for neuroblastoma were enrolled. On 4 days of each 5-day antibody cycle, 70% ethanol was administered instead of heparin to dwell in each patient's mediport overnight. We used clinical monitoring/questionnaires to assess symptoms and measured blood ethanol levels and liver functions. Patients were tracked for positive blood cultures. Time to infection for ethanol-lock–treated patients was compared with historical controls. Results We administered 123 ethanol-locks. No adverse symptoms attributable to ethanol occurred; one patient's urticaria worsened. Blood ethanol levels averaged 11 mg/dL. The study was voluntarily suspended after 3 patients' catheters became occluded, 1 of which fractured. A positive blood culture occurred in 1 (8%) of 12 patients, but suspension of the study precluded statistical power to detect impact on time to infection. Conclusions Although children with mediport catheters exhibited nontoxic blood ethanol levels and a low rate of bloodstream infections following prophylactic ethanol-lock use, there was a high incidence of catheter occlusion. Adjustments are necessary before adopting ethanol-locks for routine prophylaxis against catheter infections in children. |
| doi_str_mv | 10.1016/j.jpedsurg.2010.05.014 |
| format | Article |
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We report preliminary results of a phase I trial of ethanol-lock administration to prevent mediport catheter-related bloodstream infections in children. Methods Twelve patients receiving intravenous antibody treatments for neuroblastoma were enrolled. On 4 days of each 5-day antibody cycle, 70% ethanol was administered instead of heparin to dwell in each patient's mediport overnight. We used clinical monitoring/questionnaires to assess symptoms and measured blood ethanol levels and liver functions. Patients were tracked for positive blood cultures. Time to infection for ethanol-lock–treated patients was compared with historical controls. Results We administered 123 ethanol-locks. No adverse symptoms attributable to ethanol occurred; one patient's urticaria worsened. Blood ethanol levels averaged 11 mg/dL. The study was voluntarily suspended after 3 patients' catheters became occluded, 1 of which fractured. A positive blood culture occurred in 1 (8%) of 12 patients, but suspension of the study precluded statistical power to detect impact on time to infection. Conclusions Although children with mediport catheters exhibited nontoxic blood ethanol levels and a low rate of bloodstream infections following prophylactic ethanol-lock use, there was a high incidence of catheter occlusion. Adjustments are necessary before adopting ethanol-locks for routine prophylaxis against catheter infections in children.</description><identifier>ISSN: 0022-3468</identifier><identifier>EISSN: 1531-5037</identifier><identifier>DOI: 10.1016/j.jpedsurg.2010.05.014</identifier><identifier>PMID: 20920713</identifier><language>eng</language><publisher>United States: Elsevier Inc</publisher><subject><![CDATA[Anti-Infective Agents - administration & dosage ; Anti-Infective Agents - therapeutic use ; Antibodies, Monoclonal - therapeutic use ; Bacteremia - etiology ; Bacteremia - microbiology ; Bacteremia - prevention & control ; Catheter-related bloodstream infection ; Catheter-Related Infections - etiology ; Catheter-Related Infections - microbiology ; Catheter-Related Infections - prevention & control ; Catheterization, Central Venous - adverse effects ; Catheterization, Central Venous - methods ; Catheters, Indwelling - adverse effects ; Catheters, Indwelling - microbiology ; Central venous catheter ; Cross Infection - etiology ; Cross Infection - prevention & control ; Equipment Contamination - prevention & control ; Ethanol - administration & dosage ; Ethanol - blood ; Ethanol - therapeutic use ; Ethanol-lock ; Humans ; Immunoglobulin G - therapeutic use ; Mediport ; Neuroblastoma - immunology ; Neuroblastoma - therapy ; Nosocomial infection ; Pediatrics ; Prospective Studies ; Surgery ; Treatment Outcome]]></subject><ispartof>Journal of pediatric surgery, 2010-10, Vol.45 (10), p.1961-1966</ispartof><rights>2010</rights><rights>Copyright © 2010. Published by Elsevier Inc.</rights><lds50>peer_reviewed</lds50><oa>free_for_read</oa><woscitedreferencessubscribed>false</woscitedreferencessubscribed><citedby>FETCH-LOGICAL-c525t-28d53920523bf5626e7c5b2d6d48841491150f15df895a36811d972eaf19ac853</citedby><cites>FETCH-LOGICAL-c525t-28d53920523bf5626e7c5b2d6d48841491150f15df895a36811d972eaf19ac853</cites></display><links><openurl>$$Topenurl_article</openurl><openurlfulltext>$$Topenurlfull_article</openurlfulltext><thumbnail>$$Tsyndetics_thumb_exl</thumbnail><linktohtml>$$Uhttps://www.sciencedirect.com/science/article/pii/S0022346810004215$$EHTML$$P50$$Gelsevier$$Hfree_for_read</linktohtml><link.rule.ids>230,314,776,780,881,3537,27901,27902,65306</link.rule.ids><backlink>$$Uhttps://www.ncbi.nlm.nih.gov/pubmed/20920713$$D View this record in MEDLINE/PubMed$$Hfree_for_read</backlink></links><search><creatorcontrib>Kayton, Mark L., MD</creatorcontrib><creatorcontrib>Garmey, Edward G., MD</creatorcontrib><creatorcontrib>Ishill, Nicole M., MS</creatorcontrib><creatorcontrib>Cheung, Nai-Kong V., MD, PhD</creatorcontrib><creatorcontrib>Kushner, Brian H., MD</creatorcontrib><creatorcontrib>Kramer, Kim, MD</creatorcontrib><creatorcontrib>Modak, Shakeel, MD</creatorcontrib><creatorcontrib>Rossetto, Carol, RN, MSN</creatorcontrib><creatorcontrib>Hennelly, Courtney, RN, MS</creatorcontrib><creatorcontrib>Parra Doyle, Melissa, RN, MSN</creatorcontrib><creatorcontrib>Rosenberg, Shoshana, MPH</creatorcontrib><creatorcontrib>Santoro, Olga, BS</creatorcontrib><creatorcontrib>La Quaglia, Michael P., MD</creatorcontrib><title>Preliminary results of a phase I trial of prophylactic ethanol-lock administration to prevent mediport catheter-related bloodstream infections</title><title>Journal of pediatric surgery</title><addtitle>J Pediatr Surg</addtitle><description>Abstract Background Catheter-related bloodstream infections remain costly with no simple prevention. We report preliminary results of a phase I trial of ethanol-lock administration to prevent mediport catheter-related bloodstream infections in children. Methods Twelve patients receiving intravenous antibody treatments for neuroblastoma were enrolled. On 4 days of each 5-day antibody cycle, 70% ethanol was administered instead of heparin to dwell in each patient's mediport overnight. We used clinical monitoring/questionnaires to assess symptoms and measured blood ethanol levels and liver functions. Patients were tracked for positive blood cultures. Time to infection for ethanol-lock–treated patients was compared with historical controls. Results We administered 123 ethanol-locks. No adverse symptoms attributable to ethanol occurred; one patient's urticaria worsened. Blood ethanol levels averaged 11 mg/dL. The study was voluntarily suspended after 3 patients' catheters became occluded, 1 of which fractured. A positive blood culture occurred in 1 (8%) of 12 patients, but suspension of the study precluded statistical power to detect impact on time to infection. Conclusions Although children with mediport catheters exhibited nontoxic blood ethanol levels and a low rate of bloodstream infections following prophylactic ethanol-lock use, there was a high incidence of catheter occlusion. Adjustments are necessary before adopting ethanol-locks for routine prophylaxis against catheter infections in children.</description><subject>Anti-Infective Agents - administration & dosage</subject><subject>Anti-Infective Agents - therapeutic use</subject><subject>Antibodies, Monoclonal - therapeutic use</subject><subject>Bacteremia - etiology</subject><subject>Bacteremia - microbiology</subject><subject>Bacteremia - prevention & control</subject><subject>Catheter-related bloodstream infection</subject><subject>Catheter-Related Infections - etiology</subject><subject>Catheter-Related Infections - microbiology</subject><subject>Catheter-Related Infections - prevention & control</subject><subject>Catheterization, Central Venous - adverse effects</subject><subject>Catheterization, Central Venous - methods</subject><subject>Catheters, Indwelling - adverse effects</subject><subject>Catheters, Indwelling - microbiology</subject><subject>Central venous catheter</subject><subject>Cross Infection - etiology</subject><subject>Cross Infection - prevention & control</subject><subject>Equipment Contamination - prevention & control</subject><subject>Ethanol - administration & dosage</subject><subject>Ethanol - blood</subject><subject>Ethanol - therapeutic use</subject><subject>Ethanol-lock</subject><subject>Humans</subject><subject>Immunoglobulin G - therapeutic use</subject><subject>Mediport</subject><subject>Neuroblastoma - immunology</subject><subject>Neuroblastoma - therapy</subject><subject>Nosocomial infection</subject><subject>Pediatrics</subject><subject>Prospective Studies</subject><subject>Surgery</subject><subject>Treatment Outcome</subject><issn>0022-3468</issn><issn>1531-5037</issn><fulltext>true</fulltext><rsrctype>article</rsrctype><creationdate>2010</creationdate><recordtype>article</recordtype><sourceid>EIF</sourceid><recordid>eNqFUk1v1DAQtRCILoW_UPnGKYvtxPm4VKCqQKVKIAFny2tPGqfeONjOSvsn-M1MtG0FXPDF0vjNm_F7j5ALzrac8frduB1nsGmJd1vBsMjklvHqGdlwWfJCsrJ5TjaMCVGUVd2ekVcpjYxhmfGX5EywTrCGlxvy62sE7_Zu0vFII6TF50RDTzWdB52A3tAcnfZraY5hHo5em-wMhTzoKfjCB3NPtUUCl3LU2YWJ5oBYOMCU6R6sm0PM1Og8QIZY4DidwdKdD8FiC-g9dVMPZm1Nr8mLXvsEbx7uc_Lj4_X3q8_F7ZdPN1cfbgsjhcyFaK0s8QtSlLte1qKGxsidsLWt2rbiVce5ZD2Xtm87qcu65dx2jQDd806bVpbn5PLEOy873NHgrlF7NUe3RyFU0E79_TK5Qd2Fg6pkI5qyRYK3DwQx_FwgZbV3yYD3eoKwJNXIGo9oK0TWJ6SJIaUI_dMUztTqpRrVo5dq9VIxqdBLbLz4c8entkfzEPD-BABU6uAgqmQcTAY1j6inssH9f8blPxTGo5VG-3s4QhrDEif0QXGVhGLq25qoNVAcs1QJzNpvXHrM9Q</recordid><startdate>20101001</startdate><enddate>20101001</enddate><creator>Kayton, Mark L., MD</creator><creator>Garmey, Edward G., MD</creator><creator>Ishill, Nicole M., MS</creator><creator>Cheung, Nai-Kong V., MD, PhD</creator><creator>Kushner, Brian H., MD</creator><creator>Kramer, Kim, MD</creator><creator>Modak, Shakeel, MD</creator><creator>Rossetto, Carol, RN, MSN</creator><creator>Hennelly, Courtney, RN, MS</creator><creator>Parra Doyle, Melissa, RN, MSN</creator><creator>Rosenberg, Shoshana, MPH</creator><creator>Santoro, Olga, BS</creator><creator>La Quaglia, Michael P., MD</creator><general>Elsevier Inc</general><scope>6I.</scope><scope>AAFTH</scope><scope>CGR</scope><scope>CUY</scope><scope>CVF</scope><scope>ECM</scope><scope>EIF</scope><scope>NPM</scope><scope>AAYXX</scope><scope>CITATION</scope><scope>7X8</scope><scope>5PM</scope></search><sort><creationdate>20101001</creationdate><title>Preliminary results of a phase I trial of prophylactic ethanol-lock administration to prevent mediport catheter-related bloodstream infections</title><author>Kayton, Mark L., MD ; Garmey, Edward G., MD ; Ishill, Nicole M., MS ; Cheung, Nai-Kong V., MD, PhD ; Kushner, Brian H., MD ; Kramer, Kim, MD ; Modak, Shakeel, MD ; Rossetto, Carol, RN, MSN ; Hennelly, Courtney, RN, MS ; Parra Doyle, Melissa, RN, MSN ; Rosenberg, Shoshana, MPH ; Santoro, Olga, BS ; La Quaglia, Michael P., MD</author></sort><facets><frbrtype>5</frbrtype><frbrgroupid>cdi_FETCH-LOGICAL-c525t-28d53920523bf5626e7c5b2d6d48841491150f15df895a36811d972eaf19ac853</frbrgroupid><rsrctype>articles</rsrctype><prefilter>articles</prefilter><language>eng</language><creationdate>2010</creationdate><topic>Anti-Infective Agents - administration & dosage</topic><topic>Anti-Infective Agents - therapeutic use</topic><topic>Antibodies, Monoclonal - therapeutic use</topic><topic>Bacteremia - etiology</topic><topic>Bacteremia - microbiology</topic><topic>Bacteremia - prevention & control</topic><topic>Catheter-related bloodstream infection</topic><topic>Catheter-Related Infections - etiology</topic><topic>Catheter-Related Infections - microbiology</topic><topic>Catheter-Related Infections - prevention & control</topic><topic>Catheterization, Central Venous - adverse effects</topic><topic>Catheterization, Central Venous - methods</topic><topic>Catheters, Indwelling - adverse effects</topic><topic>Catheters, Indwelling - microbiology</topic><topic>Central venous catheter</topic><topic>Cross Infection - etiology</topic><topic>Cross Infection - prevention & control</topic><topic>Equipment Contamination - prevention & control</topic><topic>Ethanol - administration & dosage</topic><topic>Ethanol - blood</topic><topic>Ethanol - therapeutic use</topic><topic>Ethanol-lock</topic><topic>Humans</topic><topic>Immunoglobulin G - therapeutic use</topic><topic>Mediport</topic><topic>Neuroblastoma - immunology</topic><topic>Neuroblastoma - therapy</topic><topic>Nosocomial infection</topic><topic>Pediatrics</topic><topic>Prospective Studies</topic><topic>Surgery</topic><topic>Treatment Outcome</topic><toplevel>peer_reviewed</toplevel><toplevel>online_resources</toplevel><creatorcontrib>Kayton, Mark L., MD</creatorcontrib><creatorcontrib>Garmey, Edward G., MD</creatorcontrib><creatorcontrib>Ishill, Nicole M., MS</creatorcontrib><creatorcontrib>Cheung, Nai-Kong V., MD, PhD</creatorcontrib><creatorcontrib>Kushner, Brian H., MD</creatorcontrib><creatorcontrib>Kramer, Kim, MD</creatorcontrib><creatorcontrib>Modak, Shakeel, MD</creatorcontrib><creatorcontrib>Rossetto, Carol, RN, MSN</creatorcontrib><creatorcontrib>Hennelly, Courtney, RN, MS</creatorcontrib><creatorcontrib>Parra Doyle, Melissa, RN, MSN</creatorcontrib><creatorcontrib>Rosenberg, Shoshana, MPH</creatorcontrib><creatorcontrib>Santoro, Olga, BS</creatorcontrib><creatorcontrib>La Quaglia, Michael P., MD</creatorcontrib><collection>ScienceDirect Open Access Titles</collection><collection>Elsevier:ScienceDirect:Open Access</collection><collection>Medline</collection><collection>MEDLINE</collection><collection>MEDLINE (Ovid)</collection><collection>MEDLINE</collection><collection>MEDLINE</collection><collection>PubMed</collection><collection>CrossRef</collection><collection>MEDLINE - Academic</collection><collection>PubMed Central (Full Participant titles)</collection><jtitle>Journal of pediatric surgery</jtitle></facets><delivery><delcategory>Remote Search Resource</delcategory><fulltext>fulltext</fulltext></delivery><addata><au>Kayton, Mark L., MD</au><au>Garmey, Edward G., MD</au><au>Ishill, Nicole M., MS</au><au>Cheung, Nai-Kong V., MD, PhD</au><au>Kushner, Brian H., MD</au><au>Kramer, Kim, MD</au><au>Modak, Shakeel, MD</au><au>Rossetto, Carol, RN, MSN</au><au>Hennelly, Courtney, RN, MS</au><au>Parra Doyle, Melissa, RN, MSN</au><au>Rosenberg, Shoshana, MPH</au><au>Santoro, Olga, BS</au><au>La Quaglia, Michael P., MD</au><format>journal</format><genre>article</genre><ristype>JOUR</ristype><atitle>Preliminary results of a phase I trial of prophylactic ethanol-lock administration to prevent mediport catheter-related bloodstream infections</atitle><jtitle>Journal of pediatric surgery</jtitle><addtitle>J Pediatr Surg</addtitle><date>2010-10-01</date><risdate>2010</risdate><volume>45</volume><issue>10</issue><spage>1961</spage><epage>1966</epage><pages>1961-1966</pages><issn>0022-3468</issn><eissn>1531-5037</eissn><abstract>Abstract Background Catheter-related bloodstream infections remain costly with no simple prevention. We report preliminary results of a phase I trial of ethanol-lock administration to prevent mediport catheter-related bloodstream infections in children. Methods Twelve patients receiving intravenous antibody treatments for neuroblastoma were enrolled. On 4 days of each 5-day antibody cycle, 70% ethanol was administered instead of heparin to dwell in each patient's mediport overnight. We used clinical monitoring/questionnaires to assess symptoms and measured blood ethanol levels and liver functions. Patients were tracked for positive blood cultures. Time to infection for ethanol-lock–treated patients was compared with historical controls. Results We administered 123 ethanol-locks. No adverse symptoms attributable to ethanol occurred; one patient's urticaria worsened. Blood ethanol levels averaged 11 mg/dL. The study was voluntarily suspended after 3 patients' catheters became occluded, 1 of which fractured. A positive blood culture occurred in 1 (8%) of 12 patients, but suspension of the study precluded statistical power to detect impact on time to infection. Conclusions Although children with mediport catheters exhibited nontoxic blood ethanol levels and a low rate of bloodstream infections following prophylactic ethanol-lock use, there was a high incidence of catheter occlusion. Adjustments are necessary before adopting ethanol-locks for routine prophylaxis against catheter infections in children.</abstract><cop>United States</cop><pub>Elsevier Inc</pub><pmid>20920713</pmid><doi>10.1016/j.jpedsurg.2010.05.014</doi><tpages>6</tpages><oa>free_for_read</oa></addata></record> |
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| subjects | Anti-Infective Agents - administration & dosage Anti-Infective Agents - therapeutic use Antibodies, Monoclonal - therapeutic use Bacteremia - etiology Bacteremia - microbiology Bacteremia - prevention & control Catheter-related bloodstream infection Catheter-Related Infections - etiology Catheter-Related Infections - microbiology Catheter-Related Infections - prevention & control Catheterization, Central Venous - adverse effects Catheterization, Central Venous - methods Catheters, Indwelling - adverse effects Catheters, Indwelling - microbiology Central venous catheter Cross Infection - etiology Cross Infection - prevention & control Equipment Contamination - prevention & control Ethanol - administration & dosage Ethanol - blood Ethanol - therapeutic use Ethanol-lock Humans Immunoglobulin G - therapeutic use Mediport Neuroblastoma - immunology Neuroblastoma - therapy Nosocomial infection Pediatrics Prospective Studies Surgery Treatment Outcome |
| title | Preliminary results of a phase I trial of prophylactic ethanol-lock administration to prevent mediport catheter-related bloodstream infections |
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