Anticipated impact of recent ethanol lock shortage and price increase on practice among pediatric intestinal rehabilitation programs across the United States.
CLABSI
CRBSI
ethanol lock therapy
intestinal failure
parenteral nutrition
short bowel syndrome
venous access
Journal
JPEN. Journal of parenteral and enteral nutrition
ISSN: 1941-2444
Titre abrégé: JPEN J Parenter Enteral Nutr
Pays: United States
ID NLM: 7804134
Informations de publication
Date de publication:
02 2022
02 2022
Historique:
pubmed:
30
4
2021
medline:
1
4
2022
entrez:
29
4
2021
Statut:
ppublish
Résumé
Ethanol lock use has been associated with significantly lower rates of central line-associated bloodstream infection (CLABSI) in children with intestinal failure. Concerns have been raised among intestinal rehabilitation program providers regarding the impact of recent changes in cost and availability of ethanol locks in the US. We conducted a survey among the members of the North American Society For Pediatric Gastroenterology, Hepatology & Nutrition Intestinal Rehabilitation Special Interest Group (NASPGHAN IR-SIG) regarding practice changes among providers to tackle this issue and the anticipated effect on CLABSI rates. The results show that the vast majority of US participants use ethanol locks in their population with intestinal failure, with most anticipating or already experiencing reduction in access to ethanol locks. Most worrisome is that more than half of participating programs expect an increase in CLABSI rates in this vulnerable patient population as a consequence of limited access to ethanol locks. Further multicenter prospective studies to assess the efficacy of alternative locking agents, besides ethanol, are needed in order to have readily available and affordable options for CLABSI prevention in the future.
Sections du résumé
BACKGROUND
Ethanol lock use has been associated with significantly lower rates of central line-associated bloodstream infection (CLABSI) in children with intestinal failure. Concerns have been raised among intestinal rehabilitation program providers regarding the impact of recent changes in cost and availability of ethanol locks in the US.
METHODS
We conducted a survey among the members of the North American Society For Pediatric Gastroenterology, Hepatology & Nutrition Intestinal Rehabilitation Special Interest Group (NASPGHAN IR-SIG) regarding practice changes among providers to tackle this issue and the anticipated effect on CLABSI rates.
RESULTS
The results show that the vast majority of US participants use ethanol locks in their population with intestinal failure, with most anticipating or already experiencing reduction in access to ethanol locks. Most worrisome is that more than half of participating programs expect an increase in CLABSI rates in this vulnerable patient population as a consequence of limited access to ethanol locks.
CONCLUSION
Further multicenter prospective studies to assess the efficacy of alternative locking agents, besides ethanol, are needed in order to have readily available and affordable options for CLABSI prevention in the future.
Substances chimiques
Ethanol
3K9958V90M
Types de publication
Journal Article
Multicenter Study
Research Support, Non-U.S. Gov't
Langues
eng
Sous-ensembles de citation
IM
Pagination
319-323Informations de copyright
© 2021 American Society for Parenteral and Enteral Nutrition.
Références
Raphael BP, Hazekamp C, Samnaliev M, Ozonoff A. Analysis of Healthcare Institutional Costs of Pediatric Home Parenteral Nutrition Central Line Infections. J Pediatr Gastroenterol Nutr. 2018;67(4):e77-e81.
Stevens V, Geiger K, Concannon C, Nelson RE, Brown J, Dumyati G. Inpatient costs, mortality and 30-day re-admission in patients with central-line-associated bloodstream infections. Clin Microbiol Infect. 2014;20(5):O318-24.
Cober MP, Kovacevich DS, Teitelbaum DH. Ethanol-lock therapy for the prevention of central venous access device infections in pediatric patients with intestinal failure. JPEN J Parenter Enteral Nutr. 2011;35(1):67-73.
Mokha JS, Davidovics ZH, Samela K, Emerick K. Effects of ethanol lock therapy on central line infections and mechanical problems in children with intestinal failure. JPEN J Parenter Enteral Nutr. 2017;41(4):625-631.
Rahhal R, Abu-El-Haija MA, Fei L, Ebach D, Orkin S, Kiscaden E. Systematic review and meta-analysis of the utilization of ethanol locks in pediatric patients with intestinal failure. JPEN J Parenter Enteral Nutr. 2018;42(4):690-701.
Dahm K, Grossner D, Knipper A, Soehendra N, Vogel H. Annular pancreas (author's transl). Article in German. Zentralbl Chir. 1978;103(20):1349-1356.
Mezoff EA, Galloway D, Cole CR. Heightened central line-associated blood stream infection risk during a pandemic. J Pediatr Gastroenterol Nutr. 2020;70(6):e140-e141.
Ralls MW, Blackwood RA, Arnold MA, Partipilo ML, Dimond J, Teitelbaum DH. Drug shortage-associated increase in catheter-related blood stream infection in children. Pediatrics. 2012;130(5):e1369-e1373.
Vanegas Calderon O, Rahhal R. 30% ethanol locks are effective in preventing central line-associated bloodstream infections in pediatric intestinal failure: a pilot study. Nutr Clin Pract. 2021;36(2):427-432.
Harris PA, Taylor R, Minor BL, et al; REDCap Consortium. The REDCap consortium: building an international community of software platform partners. J Biomed Inform. 2019;95:103208.
Harris PA, Taylor R, Thielke R, Payne J, Gonzalez N, Conde JG. Research electronic data capture (REDCap)-a metadata-driven methodology and workflow process for providing translational research informatics support. J Biomed Inform. 2009;42(2):377-381.
Zhang J, Wang B, Wang J, Yang Q. Ethanol locks for the prevention of catheter-related infection in patients with central venous catheter: A systematic review and meta-analysis of randomized controlled trials. PLoS One. 2019;14(9):e0222408.
<number>13.number>Drews BB, Sanghavi R, Siegel JD, Metcalf P, Mittal NK. Characteristics of catheter-related bloodstream infections in children with intestinal failure: implications for clinical management. Gastroenterol Nurs. 2009;32(6):385-390; quiz 91-2.
Crnich CJ, Halfmann JA, Crone WC, Maki DG. The effects of prolonged ethanol exposure on the mechanical properties of polyurethane and silicone catheters used for intravascular access. Infect Control Hosp Epidemiol. 2005;26(8):708-714.
Landry DL, Braden GL, Gobeille SL, Haessler SD, Vaidya CK, Sweet SJ. Emergence of gentamicin-resistant bacteremia in hemodialysis patients receiving gentamicin lock catheter prophylaxis. Clin J Am Soc Nephrol. 2010;5(10):1799-804.
Venditto M, du Montcel ST, Robert J, Trystam D, Dighiero J, Hue D. Effect of catheter-lock solutions on catheter-related infection and inflammatory syndrome in hemodialysis patients: heparin versus citrate 46% versus heparin/gentamicin. Blood Purif. 2010;29(3):268-273.
Lambe C, Poisson C, Talbotec C, Goulet O. Strategies to reduce catheter-related bloodstream infections in pediatric patients receiving home parenteral nutrition: the efficacy of taurolidine-citrate prophylactic-locking. JPEN J Parenter Enteral Nutr. 2018;42(6):1017-1025.
Liu F, Hansra S, Crockford G, Köster W, Allan BJ, Blondeau JM. Tetrasodium EDTA is effective at eradicating biofilms formed by clinically relevant microorganisms from patients’ central venous catheters. mSphere. 2018;3(6):e00525-18.
Ralls MW, Blackwood RA, Arnold MA, Partipilo ML, Dimond J, Teitelbaum DH. Drug shortage-associated increase in catheter-related blood stream infection in children. Pediatrics. 2012;130(5):e1369-e1373.