Journal article
Systematic Review and Meta-Analysis of the Utilization of Ethanol Locks in Pediatric Patients With Intestinal Failure
JPEN. Journal of parenteral and enteral nutrition, Vol.42(4), pp.690-701
05/2018
DOI: 10.1177/0148607117722753
PMCID: PMC6552670
PMID: 28767319
Abstract
Intestinal failure is a chronic condition related to loss of bowel length and/or function, resulting in dependence on central venous catheters for fluids and nutrition. Catheter use can be associated with significant complications, including catheter-related bloodstream infections (CRBSIs), which can lead to loss of vascular access, advancing intestinal failure associated-liver disease and death. Our objective was to evaluate the effectiveness and safety of ethanol locks as compared with standard heparin locks in pediatric intestinal failure.
Databases, including MEDLINE and EMBASE, were searched until March 2017. Titles and abstracts were reviewed independently and relevant articles reassessed by full-text review. The main outcome was the rate of CRBSIs, while secondary outcomes were catheter replacement and repair.
Nine observational studies were included. The mean difference in rate of CRBSIs was 6.27 per 1000 catheter days (95% CI, 4.89-7.66) favoring ethanol locks, with a 63% overall reduction in infection rate. The mean difference in catheter replacement rate (per 1000 catheter days) was 4.56 (95% Cl, 2.68-6.43) favoring ethanol locks. The overall effect on catheter repair rate (per 1000 catheter days) was -1.67 (95% CI, -2.30 to -1.05), indicating lower repair rate with heparin locks.
Sufficient evidence was noted showing that ethanol locks reduced CRBSIs and catheter replacements. Our findings raise questions about the effect of the ethanol lock on catheter integrity based on the noted increase in repair rate. This requires further prospective evaluation and may support selective application of ethanol locks to patients with documented CRBSIs.
Details
- Title: Subtitle
- Systematic Review and Meta-Analysis of the Utilization of Ethanol Locks in Pediatric Patients With Intestinal Failure
- Creators
- Riad Rahhal - Division of Pediatric Gastroenterology, University of Iowa, Iowa City, Iowa, USAMaisam A Abu-El-Haija - Division of Gastroenterology, Hepatology and Nutrition, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio, USALin Fei - Division of Biostatistics and Epidemiology, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio, USADawn Ebach - Division of Pediatric Gastroenterology, University of Iowa, Iowa City, Iowa, USASarah Orkin - Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio, USAElizabeth Kiscaden - University of Iowa, Iowa City, Iowa, USAConrad R Cole - Division of Gastroenterology, Hepatology and Nutrition, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio, USA
- Resource Type
- Journal article
- Publication Details
- JPEN. Journal of parenteral and enteral nutrition, Vol.42(4), pp.690-701
- DOI
- 10.1177/0148607117722753
- PMID
- 28767319
- PMCID
- PMC6552670
- NLM abbreviation
- JPEN J Parenter Enteral Nutr
- ISSN
- 0148-6071
- eISSN
- 1941-2444
- Grant note
- T32 DK007727 / NIDDK NIH HHS
- Language
- English
- Date published
- 05/2018
- Academic Unit
- Stead Family Department of Pediatrics; Gastroenterology, Hepatology, Pancreatology, and Nutrition
- Record Identifier
- 9984093365502771
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