Generic Name:

Ethanol -lock therapy (ELT)

Designated Clinical Areas:

All Adult and Pediatric Care Areas (Excluding Neonatal)

Action:

Denatures nonspecific bacterial and fungal proteins. Possess both bactericidal and fungicidal properties with no resistance over time.

Indication:

To salvage infected central line catheters or prevent central line associated blood stream infections (CLA BSI) in adult and pediatric patients

Critical Elements/Special Considerations:

For treatment of CLA BSI, ethanol-lock therapy should not be used alone ; it should always be used in conjunction with systemic antimicrobial therapy

- Catheters should be removed if infected with S. aureus, P. aeruginosa, fungi, or mycobacteria

- In the event the ethanol-lock is inadvertently flushed into the bloodstream, ethanol lock solution is safely metabolized by the body

- Pharmacy prepared 70% ethanol-lock syringes are stable for 14 days at room temperature (23 - 25 ° C)

Administration Guidelines:

1. Prior to instillation: remove heparin from catheter and flush line with 0.9% sodium chloride
2. Instill ethanol-lock solution to fill catheter lumen or both the arterial and venous dialysis ports or each lumen of dual chamber catheters
3. Allow solution to dwell for period of time specified in physicians order. Usually dwelling duration: 4-12 hour/day; max 24 hours/day
4. After dwell time is completed- aspirate ethanol lock solution from line and flush line with 0.9% sodium chloride
5. Heparinize the line per policy if indicated (link).

Usual dose and route:

3ml of 70% ethanol flush syringes locked for 4-24hrs/day for 5days

For pediatric patients please specify the exact volume

Standard Concentration

70% ethanol (3 mL)

Precaution and Side Effects

•  Contraindications

• i. Neonatal patients

• ii. Pregnant patients

• iii. Heparin-coated catheters

• iv. PICC – must obtain approval from ID and IV nursing for use

b. Precaution

i. Alcoholic patients

•  Drug Interactions

• i. Visible precipitates have been observed in 70% ethanol solutions when combined with heparin and anticoagulant citrate solutions. Thus, 70% ethanol-lock solutions are incompatible with heparin sodium and citrate solutions.

•  Side-effects

i. tiredness, headaches, dizziness, nausea and light-headedness during instillation, arrhythmias, CNS depression

Approved by:

MESAC, 2/2010

Nursing Practice, 2/2010

Apply MESAC logo:

Contacts:

Petra Khoury, Pharm D

Janet Mulligan, RN