"The Prolonged use of Ethanol Lock Prophylaxis with Polyurethane Catheters in Children with Intestinal Failure: a single center experience".

BACKGROUND: Intestinal failure (IF) children receiving home parenteral nutrition (HPN) require long-term central venous catheters (CVCs). Ethanol lock prophylaxis (ELP) can reduce central line associated blood stream infections (CLABSIs) but there are some concerns of increased breakage rates when used with polyurethane catheters. We reviewed our experience using ethanol locks in both polyurethane and silicone CVCs.

METHODS: A 10 years retrospective study of children with IF on HPN that used ELP was conducted. Complications per 1000 catheter days were extracted and a multivariable, mixed effects Poisson model was used to compare catheter breakage rates and other complications, between polyurethane and silicone CVCs.

RESULTS: A total of ten patients were included comprising 85 CVCs and 13,227 catheter days. The most common cause of IF was necrotizing enterocolitis. Breakages were the most common complication: polyurethane 1.46/1000 vs silicone 3.76/1000 catheter days. Silicone catheters had a significantly higher breakage rate [adjusted RR 2.86, 95% CI: 2.84-2.88, p<0.001] while polyurethane catheters had higher rates of occlusion [adjusted RR 0.14, 95% CI 0.07-0.28, p<0.001] and displacements. However, there were no differences in the overall catheter replacement rates and any other catheter related outcomes.

CONCLUSIONS: In children with IF on long-term HPN, the use of ELP in polyurethane catheters was associated with lower risk of breakages when compared to silicone CVCs. These results should be regarded as preliminary data and further studies with a higher number of subjects are necessary to provide a better level of evidence. This article is protected by copyright. All rights reserved Ethanol lock prophylaxis (ELP) decreases rates of central line infection in children with intestinal failure receiving home parenteral nutrition. However, there are some concerns about increased breakage rates when applied in polyurethane central venous catheters. In this study we demonstrated that polyurethane catheters had a significantly lower breakage rate when compared to silicone, without any major adverse events. Thus, the prolonged use ELP in polyurethane catheters seems safe but our results should be regarded as preliminary data and further studies with a higher number of subjects are necessary to provide a better level of evidence.