P24 Compliance audit of ethanol linelocks for prophylaxis and treatment of central line infections
Authors: Bharania Bansri , Crook Joanne , Verma Anita 
Published: April 2023

Infections remain a devastating complication associated with vascular access devices. Removal of central venous catheter devices (CVCs) is costly, invasive and there are a finite number of access site in young children.1 2This has led to several preventative strategies. Fears of promoting drug resistance with antibiotic lock therapy and the possibility of systemic side effects have led to the use of ethanol-lock therapy (ELT). Ethanol is easily available and cheap, it is a potent germicide that can penetrate microbial biofilms, and it does not promote microbial resistance.3Current paediatric guideline has not been audited since implementation

Aim

To audit guideline compliance for inpatient paediatric patients prescribed ethanol line locks and identify potential areas of improvement.

Objectives

To identify the number of patients and indication for prescribed Ethanol line locks

To determine the number of patients prescribed the correct volume and percentage of Ethanol line lock as per policy

To identify any reported side effects and reasons for discontinuation

To identify if consent has been granted and documented

Method

Retrospective review of 46 paediatric ELT prescriptions over 4 years (2017 – 2021). These were identified using EPMA reports and dispensing records. A data collection tool was created; clinical notes and prescribing/administration records used to audit compliance to guideline.

Results

Out of 46 central line associated bloodstream infections, 36 (78%) were eradicated by ELT and 40 (87%) did not result in catheter removal. 98% of prescriptions were accurately prescribed as per guideline, only 28% had a documented indication, review and duration. 0 patients had consent to therapy documented. 1 patient experienced an adverse side effect following a prescribing error (alcohol taste in mouth).

Conclusion

Improvements in documentation required, notably for parental consent, treatment indication and duration. A change to the electronic prescribing order has been suggested to aid documentation in line with trust guidance. Although more research is required to assess the success rate of ethanol lock therapy, this retrospective study suggests that when used in conjunction with systemic antibiotics this technique has been effective in eradicating paediatric central line infections. Following this study, further research should be centred on the recurrence of central line associated bloodstream infections after initial eradication by ELT.

References

Verma A. Guidance for the use of ethanol line locks with central vascular access devices (CVAD) in paediatrics.King’s College London NHS Foundation Trust, 2015; version 2.

Hughes K, Pehovic R, Blackmer A,et al. Ethanol lock therapy in patients admitted to paediatric services. C.S. Mott Children’s Hospital, Michigan Medicine; 2020.

Onland W, Shin C, Fustar S,et al. Ethanol-lock technique for persistent bacteremia of long-term intravascular devices in paediatric patients.Arch Pediatr Adolesc Med2006;160:1049–1053.