These instructions are for Children’s Hospital of Philadelphia (CHOP) patients with a central venous catheter that have been prescribed ethanol lock therapy (ELT) to prevent central line infections.

Important information:  

• Ethanol lock therapy (ELT) is a technique used to treat and prevent central line infections.  
• Ethanol lock therapy involves filling the inside of your child’s catheter with a medical-grade ethanol solution, leaving the solution in place for several hours and then removing the ethanol. The ethanol keeps germs from growing inside of the catheter.
• If your child has a double lumen catheter, both of the lumens of the catheter may be filled with ethanol at the same time. Or you may also be instructed to fill one lumen with ethanol at a specific time and then fill the other lumen with ethanol at a different time.  This is called alternating the lumens.

Instructions for inserting 70% Ethanol Lock solution into the central venous catheter:  

1. Select a clean surface to work on. Avoid the bathroom or kitchen as these areas may have more germs in them. If you must use the kitchen, avoid areas where you prepare food. Clean the work surface with an antibacterial cleaning solution every time. 
2. Gather supplies and place them on a new, clean paper towel. You will need:
   1. Alcohol pads (or provided scrubbing device with alcohol product)
   2. Saline (0.9 % Sodium Chloride) flush syringe
   3. 70% ethanol lock solution syringe
   4. “Do Not Flush” label, if provided
3. Clean your hands with soap and water or hand sanitizer.
4. Remove the protective alcohol cap if there is one on the catheter (for example, DualCap^®, SwabCap^®, or Curos^®),   
5. Scrub the end of the needleless catheter cap with an alcohol pad for 15 seconds. Allow the cap to dry for 15 seconds. Do not blow on or fan over the cap.
6. Remove any air from the saline syringe.
7. Screw the saline syringe onto the catheter cap by turning the syringe to the right.
8. Unclamp the catheter.
9. Slowly push the saline through the catheter using push-pause technique. Keep pressure on the syringe plunger.
10. Clamp the catheter.
11. Unscrew the saline syringe from the cap by turning the syringe to the left.
12. Scrub the end of the cap with an alcohol pad for 15 seconds. Allow the cap to dry for 15 seconds. Do not blow on or fan over the cap.   
13. Remove any air from the ethanol lock syringe.  
14. Screw the ethanol lock syringe onto the catheter cap by turning the syringe to the right.  
15. Unclamp the catheter.
16. Slowly push the ethanol lock solution into the catheter. Keep pressure on the syringe plunger.   
17. Clamp the catheter.
18. Unscrew the ethanol lock syringe from the cap by turning the syringe to the left.   
19. Wrap the “Do Not Flush” label, supplied by your pharmacy, around the cap. This label is a reminder that the catheter should not be flushed while it is filled with the ethanol lock solution.
20. Your homecare provider will tell you how long the ethanol lock solution must stay in the catheter. This is called the dwell time.  
21. After that time, you will follow the instructions below to remove the ethanol lock solution from the catheter.   

Instructions for removing 70% ethanol lock solution from the central venous catheter:

1. Gather supplies and place them on a new, clean paper towel. You will need:
   1. Alcohol pads
   2. 5ml syringe
   3. Normal saline (0.9 % Sodium Chloride) flush syringe
   4. Heparin lock flush syringe
2. Clean your hands with soap and water or hand sanitizer.   
3. Remove the “Do Not Flush” label from the cap.   
4. Scrub the end of the cap with an alcohol pad for 15 seconds. Allow the cap to dry for 15 seconds. Do not blow on or fan over the cap.   
5. Screw an empty 5ml syringe onto the cap where the ethanol lock solution was inserted.   
6. Unclamp the catheter.
7. You will be taught which line to pull back to on the syringe to remove all the ethanol lock solution. There will also be blood in the syringe. The amount you pull back will be three times the amount of ethanol lock solution. For example, if the ethanol lock solution is 0.4ml, the amount you remove will be 1.2ml.

If you are unable to remove all the ethanol lock solution or have no blood return:

1. Remove as much ethanol lock solution as you can.   
2. Clamp the catheter, remove the 5ml syringe, and continue with the steps below to very slowly flush the catheter with saline.
3. Call your healthcare provider to notify them that you cannot remove the ethanol lock solution.

Note: Your child may feel tired, dizzy or light-headed, nauseated, have a headache, or complain of the taste of alcohol.

After you remove the ethanol lock solution and obtain a blood return, continue with the following steps:  

1. Clamp the catheter.  
2. Unscrew the syringe from the needleless catheter cap by turning the syringe to the left. Discard the syringe as you were instructed.  
3. Scrub the end of the cap with an alcohol pad for 15 seconds. Allow the cap to dry for 15 seconds. Do not blow on or fan over the cap.  
4. Remove any air from the saline syringe.
5. Screw the saline syringe onto the cap by turning the syringe to the right.
6. Unclamp the catheter.
7. Slowly push the saline through the catheter using push-pause technique. Keep pressure on the syringe plunger.   
8. Clamp the catheter.   
9. Unscrew the saline syringe from the cap by turning the syringe to the left.  

If the lumen that you just used for your child’s ethanol lock therapy is not going to be used, then flush with heparin as follows:

1. Scrub the end of the cap with an alcohol pad for 15 seconds. Allow the cap to dry for 15 seconds. Do not blow on or fan over the cap.  
2. Remove any air from the heparin syringe.
3. Screw the heparin syringe onto the cap by turning the syringe to the right.
4. Unclamp the catheter.   
5. Slowly push the heparin through the catheter using push-pause technique. Keep pressure on the syringe plunger.   
6. Clamp the catheter.
7. Unscrew the heparin syringe from the cap by turning the syringe to the left.  
8. If instructed to use a protective alcohol cap, scrub the end of the cap with an alcohol pad for 15 seconds. Allow the cap to dry for 15 seconds. Do not blow on or fan over the cap.
9. Screw a new protective alcohol cap onto the end of the catheter.

Note: Always flush your child’s central venous catheter with saline before and after ethanol lock therapy. Heparin cannot be mixed with ethanol lock solution. Heparin will clog your child’s central venous catheter if it comes in contact with the ethanol.

Call your healthcare provider with questions or concerns, and if:

• Your child is:
  • very tired
  • dizzy or light-headed
  • nauseous
  • complaining of headaches
  • complaining of the taste of alcohol
• You are unable to remove the Ethanol Lock solution.
• There is no blood return after removing the Ethanol Lock solution.

If you have any questions about your child’s health, please contact your child’s healthcare provider. This document is intended only to provide general educational information and is not intended as medical advice or treatment. Please consult with your healthcare provider prior to use, as some of this information may need to be adapted for your child’s specific needs. It is the responsibility of your healthcare provider to advise you on the appropriate use of this information. If you/your child are not already a CHOP patient, this document does not create a doctor-patient relationship between you/your child and CHOP. CHOP is not responsible for any outcomes you/your child might experience from your use of this document. This document is provided "AS IS", WITHOUT WARRANTIES OR CONDITIONS OF ANY KIND, express or implied. If this document refers to any drugs or medical devices, it is the responsibility of your healthcare provider to check the FDA status prior to use. If this document includes references to drug dosing, please do not rely on this document. Your healthcare provider should check the package insert for each drug before use. Hyperlinks used within this document may not be translated into other languages.

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