Inpatient Clinical Pathway for Children Eligible for Ethanol or Antibiotic/Antifungal Central Venous Catheters (CVC) Lock Therapy
Patients Eligible for Ethanol or Antibiotic/Antifungal Central Venous Catheters (CVC) Lock Therapy
Ethanol locks are first choice for lock therapy unless contraindicated due to catheter material.- Primary attending MD and frontline ordering clinician (FLOC)
- Review CLABSI history and line type to determine appropriate lock to order:
- Ethanol (primarily for silicone lines*), Antimicrobial: Amikacin, Cefazolin, Gentamicin, Vancomycin, Ceftazidime or Amphotericin B (Reviewing dosing and contraindications)
*Some units are trialing ethanol in polyurethane lines
- Ethanol (primarily for silicone lines*), Antimicrobial: Amikacin, Cefazolin, Gentamicin, Vancomycin, Ceftazidime or Amphotericin B (Reviewing dosing and contraindications)
- Collaborate with bedside RN to confirm if dwell time ≥ 4 hours available each day
- FLOC to order “Vascular Access Care notification” to initiate appropriate ALT dose calculation
- Review CLABSI history and line type to determine appropriate lock to order:
- Ethanol lock therapy (ELT) order pended by VAS; reviewed and signed by FLOC
- Antibiotic/antifungal
- Lock therapy (ALT) order pended by VAS; reviewed and signed by FLOC
Bedside RN consults VAS to coordinate Lock instillation
- VAS RN/Local VAS Resource and Bedside RN
- Retrieve lock from medication room
- Review order in Epic and perform 6 rights of medication administration
- Review Medication Administration Policy
- Lock Instillation by VAS RN/Local VAS Resource
- Review Indwelling Lock Therapy for Central Venous Catheter Procedure
VAS RN/Local VAS Resource consult in system for future removal of Lock
- Lock Removal by VAS RN/Local VAS Resource or Qualified RN
- Review Indwelling Lock Therapy for Central Venous Catheter Procedure
Reviewed by Children's Hospital of Philadelphia Clinical Care Committee: August 2019
Posted: August 2019Revised: April 2022
Authors: L. Handy, MD; T. Metjian, PharmD; L. Riede, RN; A. Frey, RN; C. Czajka, RN; M. Niewinski, RN; C. Jefferies, RN; A. Shepherd, RN; S. Suico, RN; T. Ortiz, RN; L. Polier, RN; T. Brinkley, RN; C. Woods-Hill, MD; S. Watts, CRNP; S. Robbins Tighe, CRNP; K. Morris, MD; L. Srinivasan, MD; S. Coffin, MD; J. Gomes, PharmD; MD; T. Bales, MD; L. Wolverton, CRNP; M. Boettcher, CRNP; J. Abraitis, RN.
Evidence
- Antimicrobial Lock Solutions as a Method to Prevent Central Line–Associated Bloodstream Infections: A Meta-analysis of Randomized Controlled Trials
- Efficacy in the Reduction of Central Line-Associated Bloodstream Infection in a Patient with Intestinal Failure: An Ethanol Lock Pediatric Case Study
- Ethanol Locks to Prevent Catheter-Related Bloodstream Infections in Parenteral Nutrition: A Meta-Analysis
- Ethanol-lock Technique for Persistent Bacteremia of Long-term Intravascular Devices in Pediatric Patients
- Ethanol-Lock Technique in the Treatment of Bloodstream Infections in Pediatric Oncology Patients With Broviac Catheter
- Ethanol-Lock Technique for Persistent Bacteremia of Long-term Intravascular Devices in Pediatric Patients
- Use of Ethanol Lock Therapy to Reduce the Incidence of Catheter-related Bloodstream Infections in Home Parenteral Nutrition Patients
- Ethanol Lock Therapy to Treat Tunnelled Central Venous Catheter-associated Blood Stream Infections: Results from a Prospective Trial
- Treatment and Secondary Prophylaxis with Ethanol Lock Therapy for Central Line-associated Bloodstream Infection in Paediatric Cancer: a Randomised, Double-blind, Controlled Trial