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
    • 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
  • 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
VAS RN/Local VAS Resource consult in system for future removal of Lock

Reviewed by Children's Hospital of Philadelphia Clinical Care Committee: August 2019

Posted: August 2019
Revised: 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.